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Randomized Controlled Trial
. 2017 Mar 6;12(1):31.
doi: 10.1186/s13012-017-0559-y.

A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices-process evaluation of a cluster randomized trial

Cornelia Jäger  1 , Jost Steinhäuser  2 , Tobias Freund  3 , Sarah Kuse  3 , Joachim Szecsenyi  3 , Michel Wensing  3
Affiliations
Randomized Controlled Trial

A tailored programme to implement recommendations for multimorbid patients with polypharmacy in primary care practices-process evaluation of a cluster randomized trial

Cornelia Jäger et al. Implement Sci. .

Abstract

Background: We developed and evaluated a tailored programme to implement three evidence-based recommendations for multimorbid patients with polypharmacy into primary care practices: structured medication counselling including brown bag reviews, the use of medication lists and medication reviews. No effect on the primary outcome was found. This process evaluation aimed to identify factors associated with outcomes by exploring nine hypotheses specified in the logic model of the tailored programme.

Methods: The tailored programme was developed with respect to identified determinants of practice and consisted of a workshop for practice teams, elaboration of implementation action plans, aids for medication reviews, a multilingual info-tool for patients on a tablet PC, posters and brown paper bags as reminders for patients. The tailored programme was evaluated in a cluster randomized trial. The process evaluation was based on various data sources: interviews with general practitioners and medical assistants of the intervention group and a survey with general practitioners of the intervention and control group, written reports on the implementation action plans, documentation forms for structured medication counselling and the log file of the info-tool.

Results: We analyzed 12 interviews, 21 questionnaires, 120 documentation forms for medication counselling, 5 implementation action plans and one log file of the info-tool. The most frequently reported effect of the tailored programme was the increase of awareness for the health problem and the recommendations, while implementation of routine processes was only reported for structured medication counselling. The survey largely confirmed the usefulness of the applied strategies, yet the interviews provided a more detailed understanding of the actual use of the strategies and several suggestions for modifications of the tailored programme.

Conclusions: The tailored programme seemed to have induced awareness as a first step of behaviour change. Several modifications of the tailored programme may enhance its effectiveness such as conducting outreach visits instead of a workshop, improved targeting, provision of evidence, integration of tools into the practice software and information materials in tailored formats.

Trial registration: This study is linked to an outcome evaluation study with the registration ISRCTN34664024 , assigned 14/08/2013.

Keywords: Brown bag review; Communication; Implementation; Medication list; Polypharmacy; Primary care; Process evaluation.

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Figures

Fig. 1
Fig. 1
Logic model of the tailored programme. The figure describes the assumed mechanism of the intervention and the structure of the evaluation: An implementation programme consisting of various strategies to address specific determinants of practice will increase the implementation of evidence-based recommendations. Based on previous evidence, it can be assumed that increased implementation will result in improve health outcomes. Therefore, the primary outcome is the “degree of implementation” while the effects of the recommendations are secondary outcomes. The relevance and modification of determinants and the use and helpfulness of the strategies are subject of the process evaluation.
Fig. 2
Fig. 2
Behaviour change model according to [46]
See this image and copyright information in PMC

References

    1. Hakkarainen KM, Hedna K, Petzold M, Hagg S. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions - a meta-analysis. PLoS One. 2012;7(3):e33236. doi: 10.1371/journal.pone.0033236. - DOI - PMC - PubMed
    1. Brettschneider C, Leicht H, Bickel H, Dahlhaus A, Fuchs A, Gensichen J, et al. Relative impact of multimorbid chronic conditions on health-related quality of life - results from the MultiCare Cohort Study. PLoS One. 2013;8(6):e66742. doi: 10.1371/journal.pone.0066742. - DOI - PMC - PubMed
    1. Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004;329(7456):15–9. doi: 10.1136/bmj.329.7456.15. - DOI - PMC - PubMed
    1. Avery AJ, Ghaleb M, Barber N, Dean Franklin B, Armstrong SJ, Serumaga B, et al. The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review. Br J Gen Pract. 2013;63(613):e543–53. doi: 10.3399/bjgp13X670679. - DOI - PMC - PubMed
    1. Freund T, Campbell SM, Geissler S, Kunz CU, Mahler C, Peters-Klimm F, et al. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions. Ann Fam Med. 2013;11(4):363–70. doi: 10.1370/afm.1498. - DOI - PMC - PubMed

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