Barriers and facilitators for implementation of automated home medication dispensers in home care from Dutch professionals' perspective: a qualitative study.

Abstract

Present-day home care needs to be more efficiently organized in view of the ageing of the population and the current nursing shortages. Ensuring safe medication use is part of the challenge. The number of required visits could be reduced if automated home medication dispensers (AHMD) are adequately implemented. However, the barriers and facilitators for implementation are unknown. We aimed to explore determinants (barriers, facilitators or both) for implementing AHMD in home care, from home care nurses' perspective. Semistructured interviews were conducted with home care nurses. Determinants were identified through thematic content analysis. The first four transcripts were coded inductively. Then, a code tree was developed based on the Tailored Implementation for Chronic Diseases checklist, consisting of seven domains. Each code/determinant was then labelled as a barrier, facilitator or both. Fifteen home care nurses were interviewed. The most relevant domains were innovation factors, individual health professional factors and patient factors. The most mentioned barrier was the required unplanned visits when patients do not withdraw medication within the scheduled time limit (alarm). According to our respondents, carefully assessing patients' eligibility (e.g. learnability) and properly instructing and guiding them will help prevent these alarms from happening. Next to these determinants, motivating patients to start using an AHMD and professionals having sufficient knowledge and confidence were the most mentioned facilitators. An overview of 78 determinants from nurses' perspective for implementation of AHMD in home care was established. This should form the basis for developing strategies for implementing AHMD in home care. Further research is recommended to investigate the perceived determinants from the patients', relatives' and informal caregivers' perspectives, and to prioritize the determinants from all perspectives.