4CPS-243 A nested qualitative study of medication reviews within a multicentre cluster-randomised crossover trial (medbridge)

BackgroundThe MedBridge study is a multicentre cluster-randomised crossover trial to study the effects of hospital-initiated medication reviews, including active follow-up, on elderly patients’ healthcare utilisation compared to the usual care. Pragmatic trials of complex interventions are often criticised, because of a lack of understanding of the context and the degree of implementation of the interventions in daily practice. As a first step in such an evaluation process, we present this nested qualitative study within the MedBridge study.PurposeThe purpose of this study was to identify facilitating and impeding factors in the implementation of the interventions in the MedBridge study from the perspective of the participating physicians and pharmacists.Material and methodsSemi-structured interviews were conducted with eight physicians and four pharmacists involved in the MedBridge study at Uppsala University Hospital. The interviews were recorded and transcribed. Two researchers analysed and coded the transcripts independently using the Consolidated Framework for Implementation Research, and consensus was sought.ResultsSeveral facilitators were identified, such as the belief that medication reviews lead to positive health outcomes for the patients, a positive attitude towards collaboration and the participation of pharmacists in the medical rounds. Some barriers mentioned were time limitation and different perspectives on roles and responsibilities.ConclusionBoth facilitating and impeding factors in the implementation of the medication reviews were identified, which provides valuable understanding of the effects of the interventions within the MedBridge study. Further steps in the evaluation process need to be taken in order to triangulate these findings and to evaluate the implementation of the study interventions at the other study sites as well.References and/or AcknowledgementsWe would like to thank all participating pharmacists and physicians for their valuable time and input.No conflict of interest