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A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.ORCID iD: 0000-0001-5173-5005
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
St Joan Deu Hosp, Int Off, Barcelona, Spain.
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2019 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 15, no 11, p. 1309-1316Article in journal (Refereed) Published
Abstract [en]

Background: Medication reviews have been introduced as healthcare interventions to decrease inappropriate polypharmacy in older patients, but implementation in practice is challenging.

Objective: This case study aimed to explore the events, actions and other factors that were involved in the implementation and sustainability of medication reviews in older patients by clinical pharmacists in Region Uppsala, Sweden.

Methods: A case study design informed by change management principles (Kotter) and normalization process theory, consisting of a review of published and grey literature, key informant interviews and focus group triangulation. Findings from additional literature review and interviews were integrated into a final thematic analysis. Ten healthcare professionals, managers and policy makers participated as key informants. The study included data up to 2015.

Results: Factors were identified across all Kotter's principles and normalization process theory domains, ranging from the first evidence on inappropriate polypharmacy in the 1980s until the creation of permanent clinical pharmacist positions in recent years. Examples of facilitating factors were a national focus on quality of care for the elderly, multiprofessional teamwork, key individuals with different professions, education, financial support and local evidence. Barriers included an unclear allocation of tasks and responsibilities, a lack of time and continuity, and a lack of a national plan for implementation, monitoring and evaluation.

Conclusions: Multiple factors across the full range of change management and implementation principles were involved in the implementation and sustainability. A systems approach, including these factors, should be considered in similar future initiatives, both in Sweden and settings in other countries.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2019. Vol. 15, no 11, p. 1309-1316
Keywords [en]
Implementation research, Change management, Multiprofessional teams, Medication management, Clinical pharmacy, Case study
National Category
Social and Clinical Pharmacy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:uu:diva-397592DOI: 10.1016/j.sapharm.2018.12.006ISI: 000493902700004PubMedID: 30606682OAI: oai:DiVA.org:uu-397592DiVA, id: diva2:1372576
Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2019-11-25Bibliographically approved

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Kempen, ThomasGillespie, Ulrika

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Clinical pharmacogenomics and osteoporosisDepartment of Medical SciencesDepartment of Pharmaceutical Biosciences
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Social and Clinical PharmacyHealth Care Service and Management, Health Policy and Services and Health Economy

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