Abstract
PurposeThere is a lack of knowledge about factors that influence the performance of comprehensive medication reviews (CMRs) by multiprofessional teams in hospital practice. This study aimed to explore the facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients from the healthcare professional perspective.MethodsPhysicians and ward-based pharmacists were recruited from an ongoing trial at four hospitals in Sweden. Semi-structured interviews were conducted with 16 physicians and 7 pharmacists. Interview topics were working processes, resources, competences, medication-related problems, intervention effects and collaboration. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Identified subthemes were categorised as facilitators or barriers and grouped into overarching main themes.ResultsIn total, 21 facilitators and 25 barriers were identified across all CFIR domains and grouped in 6 main themes: (a) CMRs and follow-up are needed, but not in all patients; (b) there is a general belief in positive effects; (c) lack of resources is an issue, although the performance of CMRs may save time; (d) pharmacists’ knowledge and skills are valuable, but they need more clinical competence; (e) compatibility with hospital practice is challenging, and roles and responsibilities are unclear and (f) personal contact at the ward is essential for physician-pharmacist collaboration.ConclusionMultiple facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients exist. These factors should be addressed in future initiatives with similar interventions by multiprofessional teams to ensure successful implementation and performance in hospital practice.
Highlights
Mismanaged prescribing and inappropriate use of medications among older people are a major cause of avoidable harm in healthcare systems across the world [1,2,3]
Less is known about the effects on hard clinical endpoints, justifying the need for high-quality randomised controlled trials (RCTs) [10]
This RCT aims to study the effects of two interventions compared with usual care on older patients’ health outcomes: (1) a comprehensive medication reviews (CMRs) by a ward-based pharmacist in collaboration with the physician and patient during hospital stay; and (2) the same as the first intervention, with the addition of a follow-up phone call by the pharmacist 2– 7 days and 1–2 months after hospital discharge, and a medication referral to the patient’s general practitioner (GP) upon discharge if necessary
Summary
Mismanaged prescribing and inappropriate use of medications among older people are a major cause of avoidable harm in healthcare systems across the world [1,2,3]. To fulfil this need, the Medication Reviews Bridging Healthcare (MedBridge; www.clinicaltrials.gov: NCT02986425) trial is currently being performed at four hospitals in Sweden [11]. The Medication Reviews Bridging Healthcare (MedBridge; www.clinicaltrials.gov: NCT02986425) trial is currently being performed at four hospitals in Sweden [11] This RCT aims to study the effects of two interventions compared with usual care on older patients’ health outcomes: (1) a CMR by a ward-based pharmacist in collaboration with the physician and patient during hospital stay; and (2) the same as the first intervention, with the addition of a follow-up phone call by the pharmacist 2– 7 days and 1–2 months after hospital discharge, and a medication referral to the patient’s general practitioner (GP) upon discharge if necessary
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