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The implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting: a cross-sectional study.

Hogervorst, S., Adriaanse, M., Vervloet, M., Teichert, M., Dijk, L. van. The implementation of clinical medication reviews in community pharmacies within a multidisciplinary setting: a cross-sectional study. International Journal of Clinical Pharmacy: 2023, 45, p. 524. Abstract 595 of the 13th PCNE Working Conference “Pharmacies' new roles in pharmaceutical care: bridging research and practice”, 8-11th February, Hilleroed, Denmark
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Polypharmacy is common in chronic medication users, which increases the chance of drug related problems. A suitable intervention is the clinical medication review (CMR) that was introduced in the Netherlands ten years ago. The effectiveness might be hindered by limited implementation in community pharmacies. Factors contributing to the lack of implementation were the large number of patients eligible for a CMR, inadequate selection criteria, the time consuming and inefficient review procedure, a lack of collaboration between HCPs and insufficient reimbursement.

To get insight into the current implementation of CMRs in Dutch community pharmacies and to identify barriers to the implementation.

An online questionnaire was developed based on the Consolidated Framework for Implementation Research (CFIR) and consisted of 58 questions with open ended, multiple choice or Likertscale answering options. It was sent out to all Dutch community pharmacies (n = 1953) in January 2021. Descriptive statistics were used.

A total of 289 (14.8%) community pharmacies filled out the questionnaire. Pharmacists conducted 56 CMRs annually on average. Most pharmacists agreed that a CMR has a positive effect on the quality of pharmacotherapy (91.3%) and on medication adherence (64.3%). Pharmacists structured CMRs according to available selection criteria or guidelines (92%). Pharmacists (90%) believed that jointly conducting a CMR with a general practitioner (GP) improved their mutual relationship, whereas 21% believed it improved the relationship with a medical specialist. Lack of time was reported by 43% of pharmacists and 80% (fully) agreed conducting CMRs with a medical specialist was complicated. Most pharmacists indicated that pharmacy technicians can assist in performing CMRs, but they rarely
do in practice.

The response rate was 14.8%. This response rate is too low to take our results as representative for the whole group of community pharmacists. Assuming that those who are most involved in CMR filled out the questionnaire, our results may reflect the current best practice of CMR performance. Pharmacists in the Netherlands seem to conduct CMRs in a structured manner and major barriers including the lack of a systematic approach and suboptimal selection criteria for patients have been overcome. Lack of time is a major implementation barrier for most pharmacists. We suggest that (vocationally educated) pharmacy technicians might be able to assist the community pharmacist in conducting a CMR. Suboptimal collaboration between pharmacists and medical specialists is a major implementation barrier. Future studies should explore medical specialists’ perspectives and explore ways in which the collaboration
might be improved.