Implementation of a patient-centred complex intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): a mixed-methods process evaluation
Corral-Partearroyo, Carmen (Universitat Autònoma de Barcelona)
Sánchez-Viñas, Alba (Universitat de Barcelona)
Peñarrubia-María, María Teresa (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Gil-Girbau, Montserrat (Hospital Sant Joan de Déu)
Aznar-Lou, Ignacio (Hospital Sant Joan de Déu)
Palma-Vasquez, Claudia (Hospital Sant Joan de Déu)
Gallardo-González, Carmen (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Olmos-Palenzuela, María del Carmen (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
Rubio-Valera, Maria (Hospital Sant Joan de Déu)

Data:	2025
Resum:	Introduction: The Initial Medication Adherence (IMA) intervention aims to improve adherence to cardiovascular disease and diabetes treatments in primary care (PC) through standardised Shared Decision-Making (SDM) and Health Care Professional (HCP) collaboration (GPs, nurses, pharmacists). This study assessed the intervention's implementation (strategies, fidelity and integration into routine practice-based on the Normalisation Process Theory), mechanisms of action, and the role of context. Methods: The IMA-cRCT was an effectiveness-implementation cluster-RCT involving 24 Spanish PC centres (>300 HCP; >3,000 patients) based on real-world evidence (ClinicalTrials. gov, NCT05026775). This nested process evaluation used quantitative (monitoring data; HCP questionnaires) and qualitative methods (field diaries; 36 semistructured individual interviews and two focus groups (19 patients, 28 HCPs)). Quantitative data explored implementation and context and were analysed descriptively, while qualitative data examined implementation, mechanisms and context and were analysed using framework analysis. Both analyses were integrated for interpretation. Results: Intervention implementation fidelity (6. 5/10) and normalisation into clinical practice (7. 6/10) were adequate, particularly regarding SDM and use of decision aids. HCPs recognised the importance of SDM, although some assumed it was already part of routine practice. The anticipated mechanisms of action were moderately supported. HCPs' knowledge and attitudes towards SDM improved as they acknowledged its relevance to practice. Some patients reported participation in decision-making, while others preferred the GP to decide on their behalf. Patients found leaflets helpful for understanding information. Contextual factors influencing the intervention were mainly organisational, such as lack of time and familiarity with SDM. Conclusions: The interprofessional SDM-based IMA intervention was considered beneficial for patients and HCP, with adequate implementation fidelity and normalisation into practice. The intervention was important for HCPs, and patients accepted it. However, greater effort is needed to extend SDM throughout healthcare, moving towards patient-centred care. These results have enhanced understanding of SDM interventions and support their refinement for future implementation.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Complex Intervention ; Process evaluation ; Implementation ; Type I Hybrid Trial ; Shared Decision-Making ; Medication adherence
Publicat a:	BMJ Quality & Safety, 2025 , ISSN 2044-5423

DOI: 10.1136/bmjqs-2024-018403.

14 p, 1.7 MB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats