Implementing a person-centered medication review process at hospital: Recommendations based on a scoping review of barriers and facilitators

Abstract

Aim: To provide a person-centered set of recommendations that will help (i) healthcare professionals to implement the medication review process at hospital and (ii) tactical stakeholders to promote medication reviews as standard practice in clinical pharmacy. Background: Although the medication review process is highly relevant for the safety of individual patients and for economic purposes, it appears to be complex to implement and then maintain over time in hospital settings. The stakeholders who implement the medication review process may feel disempowered and often request guidance on how to overcome these problems. Method: We first drew up the most comprehensive possible list of barriers and facilitators (i.e., factors that respectively hinder or help the medication review process at hospitals) by searching the PubMed, Web of Science, and Science Direct databases for case studies describing the implementation of medication reconciliation and medication review processes in hospital settings. Text extracts mentioning facilitators and barriers were divided into thematic units, analysed and classified hierarchically. Based on this list of influencing factors, we developed a series of person-centered recommendations. Results: The analysis of 38 publications led to the identification of 617 factors (346 facilitators and 271 barriers) divided into 9 categories and 67 subcategories. Next, we developed a set of 71 specific recommendations for operational stakeholders on designing, implementing and performing the MRev process at hospital. The recommendations are divided into 6 main categories: Designing the process , Participants , Training , Tools , Information and Organization . We also elaborated a set of 20 key recommendations for local and national decision-makers on sustaining the implementation of the MRev process at hospital. Conclusion: We identified a large number of factors that may impact the implementation of the MRev process at hospital and which therefore have the potential to impact upon person-centeredness. Based on this list, we provide a set of recommendations for operational and tactical stakeholders on supporting the local implementation and nationwide expansion of the MRev process.