Clinical Research Directory

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

Polypharmacy is a major and growing public health concern, associated with increased risks of adverse drug events, drug interactions, and hospitalizations. Medication reviews (MedRev), defined as structured evaluations of patients' medications aiming to optimize drug use and improve health outcomes, are increasingly promoted to address these challenges. In Belgium, a reimbursed MedRev service has been implemented in community pharmacies since 2023, involving collaboration between community pharmacists (CPs) and general practitioners (GPs). The RevMedAdopt Pharmacy Study is a national prospective interventional study designed to evaluate the real-world implementation of this service. It focuses specifically on the adoption of pharmaceutical recommendations generated during medication reviews performed by pharmacy students under supervision, within the framework of their clinical training. The primary objective is to assess the adoption rate of pharmaceutical recommendations, defined as the proportion of recommendations effectively implemented in patients' medication regimens. Adoption is evaluated at 3 months (patient follow-up) and 6 months (GP follow-up) after the medication review, and categorized as fully adopted, partially adopted, not adopted, or unavailable. Secondary objectives aim to identify and assess contextual factors associated with successful implementation of recommendations. These factors include characteristics related to patients (e.g., demographics, comorbidities, medication burden), pharmacists (e.g., supervision, role as reference pharmacist), general practitioners (e.g., collaboration and communication), medication review processes (e.g., access to clinical data, communication methods), and the recommendations themselves. The study includes adult patients living at home in Belgium who are polymedicated (≥5 chronic reimbursed medications) and have both a general practitioner and a reference pharmacist. Approximately 120 patients will be recruited in this first phase. Medication reviews are conducted by final-year pharmacy students during their internships in community pharmacies, following the official Belgian MedRev framework. Students collect baseline medication data, identify drug-related problems, and formulate recommendations validated by their supervising pharmacist. These recommendations are communicated to the GP, typically via an official electronic form. Follow-up data are collected by the research team through telephone interviews with patients at 3 months and with GPs at 6 months to assess changes in medication regimens and the implementation of recommendations. In addition, qualitative semi-structured interviews with patients, GPs, and pharmacists are conducted to explore perceived barriers and facilitators influencing adoption. By combining quantitative and qualitative approaches, this study aims to provide a comprehensive understanding of the determinants of implementation of pharmacist-led medication review recommendations in primary care. The results are expected to inform improvements in interprofessional collaboration and optimization of medication review services in Belgium and similar healthcare systems.