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Implementation Factors and Strategies used by Practice Change Facilitators in an Adherence Effectiveness-Implementation Hybrid Design Study

  • At: PPR SIG 2021 (2021)
  • Type: Digital
  • By: GRAHAM, Emma Luisa (University of Granada, Spain)
  • Co-author(s): Emma L. Graham, Shalom I. (Charlie) Benrimoj, Beatriz Pérez Escamilla, Victoria García-Cárdenas, Miguel Ángel Gastelurrutia, Raquel Varas Doval, Tamara Peiro Zorrilla, Isabel Valverde Merino, Fernando Martínez Martínez
  • Abstract:


    The implementation of evidence-based healthcare innovations is complex with multiple implementation factors, that can either prevent (i.e., barriers) or enhance (i.e., facilitators) the implementation of evidence-based practice. These barriers may interact with each other and have multiple causes. A “Practice Change Facilitator” (PCF), is an individual that is responsible for identifying implementation factors and applying strategies to optimise fidelity and ultimate success.


    The objective was to identify single and combination strategies that were used to address barriers by PCFs when implementing a medication adherence program in community pharmacy.


    AdherenciaMED was a study aimed at evaluating the clinical, economic and humanistic impact and the implementation of a medication adherence service. Seven PCFs recorded data pertaining to barriers, their causes and used implementation strategies. Implementation factors were coded as per adaptation of Damschroder et al. with strategies coded as per adaptation of Dogherty et al. Data was analysed using Excel 2016 and Orange 3.28.0.


    234 barriers were identified by the PCFs, of which 50.8% (n=119) were targeted using a single implementation strategy (SIS), 26.5% (n=62) using a 2-implementation strategy combination (ISC), 10.7% (n=25) using a 3-ISC, and 12.0% (n=28) using a >3-ISC. 85.7% (n=102) of the barriers were successfully overcome using a SIS, 75.8% (n=47) when using a 2-ISC, 92.0% (n=23) when using a 3-ISC, and 89.3% (n=25) when using a >3-ISC. The most common barrier for both SIS and ISC use was “amount of time devoted to providing/implementing the service”, for which strategies such as “Engage stakeholders by creating ownership of the change” (SIS) and “Adapt area of focus to meet change needs” (ISC) were used.


    PCFs identified a multitude of barriers, for which they used SIS or ISC with a high success rate. This information can be used to improve the selection and combination of strategies in future studies.

Last update 4 October 2019

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