Abstract
BackgroundImplementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the uptake of new medicines into practice faces a wide range of obstacles. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). However, the methodological approaches used had limitations (e.g., single author, narrative review, narrow search, no quality assessment of reviewed evidence). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research.MethodA systematic search of literature was undertaken within seven databases: Medline, EMBASE, Web of Science, CINAHL, Cochrane Library, SCOPUS, and PsychINFO. Included in the review were qualitative, quantitative, and mixed-methods studies focused on adult participants (18 years and older) requiring or taking new medicine(s) for any condition, in the context of healthcare organizations and which identified factors affecting the uptake of new medicines. The methodological quality was assessed using QATSDD tool. A narrative synthesis of reported factors was conducted using framework analysis and a conceptual framework was utilised to group them.ResultsA total of 66 studies were included. Most studies (n = 62) were quantitative and used secondary data (n = 46) from various databases, e.g., insurance databases. The identified factors had a varied impact on the uptake of the different studied new medicines. Differently from earlier reviews, patient factors (patient education, engagement with treatment, therapy preferences), cost of new medicine, reimbursement and formulary conditions, and guidelines were suggested to influence the uptake. Also, the review highlighted that health economics, wider organizational factors, and underlying behaviours of adopters were not or under explored.ConclusionThis systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations, which were grouped into patient, prescriber, medicine, organizational, and external environment factors. This systematic review also identifies additional factors affecting new medicine use not reported in earlier reviews, which included patient influence and education level, cost of new medicines, formulary and reimbursement restrictions, and guidelines.RegistrationPROSPERO database (CRD42018108536).
Highlights
The uptake of an evidence-based intervention in clinical practice can take on average 17 years before it becomes part of a routine practice [1]
The authors of this review considered uptake as the use of a new medicine within a healthcare organization within five years after it had been approved by the regulatory agency of the country where the study was conducted
Summary of evidence This systematic review has identified a broad range of factors affecting the uptake of new medicines within healthcare organizations
Summary
The uptake of an evidence-based intervention in clinical practice can take on average 17 years before it becomes part of a routine practice [1]. There is a considerable amount of scientific literature exploring why the implementation of evidence-based interventions succeeds or fails within a complex healthcare environment [6]. Factors affecting implementation outcomes have been grouped into patient, provider, innovation, structural and organizational factors [7]. Earlier reviews indicated patients’ socio-demographic and economic characteristics influenced the uptake of new medicines [8,9,10]. Innovation level factors, such as effectiveness, safetyprofile, convenience, and therapeutic novelty of new medicines were considered important aspects. Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. Earlier reviews provided insights into determinants for new medicine uptake (such as medicine, prescriber, patient, organization, and external environment factors). This systematic review aims to identify barriers and facilitators affecting the uptake of new medicines into clinical practice and identify areas for future research
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