Implementation fidelity of a clinical medication review intervention: process evaluation

Area of Science:

• Geriatric Medicine
• Clinical Pharmacy
• Health Services Research

Background:

• Clinical medication reviews are crucial but under-evaluated in daily practice.
• The Opti-Med intervention utilized structured external expert teams (pharmacist and physician) for medication reviews.
• While effective in resolving drug-related problems, the intervention did not enhance patient quality of life.

Purpose of the Study:

• To conduct a process evaluation of the Opti-Med intervention.
• To assess the implementation fidelity of key intervention components.
• To understand factors influencing the successful delivery of medication reviews.

Main Methods:

• A mixed-methods design integrating quantitative and qualitative data was employed.
• Implementation fidelity was assessed using a conceptual framework, defining it as the degree of adherence to the intended intervention design.
• Data were collected alongside a cluster randomized trial involving 518 patients aged 65+ across 22 general practices.

Main Results:

• Patient selection and medication analysis preparation were largely as planned, though researchers, not practice nurses, often performed these tasks.
• Medication analyses by expert teams, patient consultations, and patient involvement proceeded as intended.
• Implementation fidelity was moderate to high, with 48% of proposed medication changes adopted; cooperation and decision-support tools aided implementation, while time constraints and data issues posed barriers.

Conclusions:

• The Opti-Med intervention demonstrated moderate to high implementation fidelity across its core components.
• Insufficient implementation fidelity does not explain the intervention's lack of effect on patient quality of life.
• Embedding the intervention within general practices influenced implementation fidelity.