Background and importance There is a lack of knowledge about factors that influence the performance of comprehensive medication reviews (CMRs) and post-discharge follow-up by multiprofessional ward teams including a clinical pharmacist. A better understanding of these factors is needed to support implementation and sustainability of CMRs or similar services by clinical pharmacists in hospital practice.
Aim and objectives This study aimed to explore the facilitators and barriers to performing CMRs and post-discharge follow-up in older hospitalised patients.
Material and methods Physicians and clinical pharmacists were recruited from an ongoing trial at eight internal medicine or geriatric wards in 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.
Results In total, 24 facilitators and 25 barriers were identified across all CFIR domains and grouped into six 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 on the ward is essential for physician–pharmacist collaboration.
Conclusion and relevance Multiple 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 including a clinical pharmacist to ensure successful implementation and sustainability in hospital practice.
References and/or acknowledgements We would like to thank all physicians and pharmacists who participated in this study.
No conflict of interest.
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