Implementing medication adherence interventions in four Dutch living labs; context matters
BMC Health Services Research, vol. 23, pp. 1030
Abstract
BACKGROUND: Despite the abundant availability of effective medication adherence interventions, uptake of these interventions into routine care often lacks. Examples of effective medication adherence interventions include telephone counseling, consult preparation and the teach-back method. Assessing context is an important step in understanding implementation success of interventions, but context is often not reported or only moderately described. This study aims to describe context-specific characteristics in four living labs prior to the implementation of evidence-based interventions aiming to improve medication adherence. METHODS: A qualitative study was conducted within four living labs using individual interviews (n = 12) and focus groups (n = 4) with project leaders and involved healthcare providers. The four living labs are multidisciplinary collaboratives that are early adopters of medication adherence interventions in the Dutch primary care system. Context is defined as the environment or setting in which the proposed change is to be implemented. Interview topics to assess context were formulated based on the 'inner setting' and 'outer setting' domains of the Consolidated Framework for Implementation Research (CFIR). Interviews were recorded and transcribed verbatim. Transcripts were deductively analyzed. RESULTS: A total of 39 community pharmacists, pharmacy technicians, general practitioners and a home care employee participated in the (focus group) interviews. All four living labs proved to be pharmacy-driven and characterized by a high regard for innovation by staff members, a positive implementation climate, high levels of leadership engagement and high compatibility between the living labs and the interventions. Two living labs were larger in size and characterized by more formal communication. Two living labs were characterized by higher levels of cosmopolitanism which resulted in more adaptable interventions. Worries about external policy, most notably lack of reimbursement for sustainment and upscaling of the interventions, were shared among all living labs. CONCLUSIONS: Contextual characteristics of four living labs that are early adopters of medication adherence interventions provide detailed examples of a positive implementation setting. These can be used to inform dissemination of medication adherence interventions in settings less experienced in implementing medication adherence interventions.
Authors 14
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Amsterdam Public Health · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
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Marcia Vervloet corresponding
Netherlands Institute for Health Services Research
Affiliation as printed
Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.vervloet@nivel.nl
Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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University of Applied Sciences Utrecht
Affiliation as printed
Hogeschool Utrecht, Lectorate Innovations in Healthcare Processes in Pharmacology, Utrecht, The Netherlands
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Affiliation as printed
Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
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Amsterdam Public Health · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center · Radboud Institute for Health Sciences
Affiliation as printed
Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Radboud University Nijmegen · Radboud University Medical Center · Sint Maartenskliniek · Radboud Institute for Health Sciences
Affiliation as printed
Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
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Affiliation as printed
Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
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Affiliation as printed
Utrecht Institute of Pharmaceutical Sciences, Divison of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
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Amsterdam Public Health · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Instituut voor Verantwoord Medicijngebruik
Affiliation as printed
Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
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Instituut voor Verantwoord Medicijngebruik
Affiliation as printed
Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
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SIR Institute for Pharmacy Practice and Policy
Affiliation as printed
SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
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University of Groningen · Netherlands Institute for Health Services Research
Affiliation as printed
Department of Pharmaceutical Care, Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
Department of PharmacoTherapy, Epidemiology and Economics (PTEE), Faculty of Mathematics and Natural Sciences, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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