Evaluating an implementation programme for medication review with follow-up in community pharmacy using a hybrid effectiveness study design: translating evidence into practice.
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.
['Varas-Doval|Raquel|R|0000-0002-0666-9739', 'Gastelurrutia|Miguel A|MA|0000-0003-1019-0234', 'Benrimoj|Shalom I|SI|0000-0001-9768-7838', 'Zarzuelo|Maria Jose|MJ|0000-0001-8635-8094', 'Garcia-Cardenas|Victoria|V|0000-0003-3770-4557', 'Perez-Escamilla|Beatriz|B|0000-0002-3209-3147', 'Martínez-Martínez|Fernando|F|0000-0001-8247-1751']
D000368:Aged D003157:Community Pharmacy Services D005500:Follow-Up Studies D006801:Humans D010594:Pharmacies D011788:Quality of Life D013030:Spain
change management health services administration & management primary care public health