Factors Determining the Rate of Adoption of Pharmaceutical Recommendations by Patients in Primary Care Following a Medication Review by a Pharmacist

Overview

Polypharmacy is a growing public health concern associated with adverse drug events, drug interactions, and hospitalizations. Medication reviews (MedRev) are structured evaluations of patients' medications aiming to optimize treatment and improve outcomes. In Belgium, a reimbursed MedRev service involving community pharmacists and general practitioners (GPs) has been implemented since 2023. The RevMedAdopt Pharmacy Study is a national prospective interventional study evaluating the real-world implementation of pharmaceutical recommendations generated during medication reviews performed by supervised final-year pharmacy students. The primary objective is to assess the adoption rate of pharmaceutical recommendations at 3 and 6 months after the medication review. Recommendations are categorized as fully adopted, partially adopted, not adopted, or unavailable. Secondary objectives are to identify factors associated with recommendation implementation, including patient characteristics, pharmacist and GP collaboration, medication review processes, and recommendation-related factors. The study includes adult polymedicated patients living at home in Belgium and followed by both a GP and a reference pharmacist. Approximately 120 patients will be recruited. Medication reviews are conducted during pharmacy internships following the official Belgian MedRev framework. Recommendations validated by supervising pharmacists are communicated to GPs. Follow-up data are collected through telephone interviews with patients and GPs. Qualitative interviews with patients, pharmacists, and GPs explore barriers and facilitators influencing recommendation adoption. This mixed-methods study aims to improve understanding of the implementation of pharmacist-led medication review recommendations in primary care and to support optimization of interprofessional collaboration and medication review services.

Polypharmacy represents a major public health issue, particularly among patients with chronic conditions, and is associated with increased risks of adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalizations. Medication reviews (MedRev), defined as structured and systematic evaluations of a patient's medication regimen, aim to optimize medication use, improve adherence, and enhance clinical outcomes. In Belgium, a reimbursed medication review service has been implemented in community pharmacies since April 2023, promoting collaboration between community pharmacists (CPs) and general practitioners (GPs). However, while such interventions generate pharmaceutical recommendations, their real-world implementation remains variable and insufficiently understood. Previous studies suggest that contextual factors, particularly related to interprofessional collaboration and communication, play a key role in determining whether recommendations are effectively adopted. The RevMedAdopt Pharmacy Study is a national prospective interventional study designed to evaluate the implementation of this MedRev service in real-life conditions. The study is embedded within the clinical training of final-year pharmacy students, who perform medication reviews under the supervision of accredited community pharmacists. The primary objective is to assess the adoption rate of pharmaceutical recommendations issued following medication reviews. Adoption is defined as the extent to which recommendations are implemented in the patient's medication regimen and is categorized as fully adopted, partially adopted (alternative action taken), not adopted, or unavailable. This outcome is measured at two time points: 3 months after the intervention (via patient follow-up) and 6 months after the intervention (via GP follow-up). Secondary objectives are to identify and assess contextual factors associated with the successful implementation of recommendations. These factors include patient-related characteristics (e.g., socio-demographic profile, comorbidities, medication burden), pharmacist-related aspects (e.g., supervision, role as reference pharmacist), GP-related aspects (e.g., involvement, collaboration with pharmacists), characteristics of the medication review process (e.g., access to clinical data, communication channels), and characteristics of the recommendations themselves (e.g., type and clinical relevance). The study population consists of adult patients living at home in Belgium who are polymedicated (defined as the use of five or more chronic reimbursed medications), and who have both a general practitioner and a reference pharmacist. Patients with insufficient language proficiency or without adequate support in case of cognitive impairment are excluded. Approximately 120 participants will be recruited in the first phase, an initial phase involving UCLouvain students. It is possible that we do an extension to other Belgian universities. The study is conducted in several sequential steps. First, pharmacy students recruit eligible patients, obtain informed consent, and conduct medication reviews, including patient interviews and pharmacotherapeutic analyses. Drug-related problems are identified, and recommendations are formulated and validated by supervising pharmacists. These recommendations are then communicated to the GP, primarily via an official electronic form (eForm), possibly complemented by additional communication methods. Follow-up is conducted by the research team. At 3 months, patients are contacted by telephone to update their medication list and assess changes. At 6 months, GPs are contacted to confirm medication changes, evaluate recommendation implementation, and collect additional clinical information. These data allow for a pre-post comparison of medication regimens and calculation of adoption rates. In addition to quantitative data collection, a qualitative component is conducted through semi-structured interviews with a subset of patients, GPs, and pharmacists. These interviews explore experiences, perceptions, barriers, and facilitators related to medication reviews and the implementation of recommendations. Data are collected using REDCap, ensuring secure and standardized data management in compliance with GDPR regulations. Quantitative analyses will assess adoption rates and their associations with contextual factors, while qualitative analyses will follow a thematic approach to identify key determinants of implementation. By combining quantitative and qualitative methods, this study aims to provide a comprehensive understanding of the mechanisms underlying the adoption of pharmacist-led medication review recommendations. The findings are expected to inform improvements in the organization, communication, and effectiveness of medication review services, and to support the development of integrated, patient-centered care models in primary care settings.