Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice

Raquel Varas-Doval, Miguel A Gastelurrutia, Shalom I Benrimoj, Maria Jose Zarzuelo, Victoria Garcia-Cardenas, Beatriz Perez-Escamilla, Fernando Martínez-Martínez, Raquel Varas-Doval, Miguel A Gastelurrutia, Shalom I Benrimoj, Maria Jose Zarzuelo, Victoria Garcia-Cardenas, Beatriz Perez-Escamilla, Fernando Martínez-Martínez

Abstract

Objectives: To evaluate an implementation programme of a community pharmacy medication review with follow-up (MRF) service using a hybrid effectiveness-implementation study design, and to compare the clinical and humanistic outcomes with those in a previously conducted cluster randomised controlled trial (cRCT).

Setting: Community pharmacies in Spain.

Participants: 135 community pharmacies and 222 pharmacists providing MRF to polymedicated patients aged 65 or over.

Intervention: The intervention was an implementation programme for the MRF service. A national level group was established, mirrored with a provincial level group. A series of interventions were defined (1) to engage pharmacy owners with the implementation model and (2) to provide training to pharmacists consisting of clinical case studies, process of MRF, communication skills and data collection methods and (3) practice change facilitators.

Primary and secondary outcome measures: The primary outcomes for the implementation programme were progress, reach, fidelity and integration. The secondary outcomes were number of medications, non-controlled health problems, emergency visits, hospitalisations and health-related quality of life, which were compared with a previous 6-month cluster RCT.

Results: 55% of pharmacies reached the implementation phase and 35.6% remained in the testing phase at 12 months. A reach of 89.3% (n=844) was achieved. Fidelity average score was 8.45 (min: 6.2, max: 9.3) out of 10. The integration mean score was 3.39 (SD: 0.72) out of 5. MRF service outcomes were similar to the cluster RCT study; however, the magnitude of the outcomes was delayed.

Conclusions: The implementation of pharmacy services is a complex multifactorial process, conditioned by numerous implementation factors. In the absence of remuneration, the implementation of the MRF service is a slow process, taking at least 12 months to complete.

Trial registration number: CGFTRA-2017-01.

Keywords: change management; health services administration & management; primary care; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Evaluative framework as adapted from Moullin et al.
Figure 2
Figure 2
Progress of pharmacies through the different phases of the Framework for the Implementation of Services in Pharmacy model.
Figure 3
Figure 3
Reach achieved in the implementation programme.

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