Smale Elisabeth M, Verkerk Eva W, Heerdink Eibert R, Egberts Toine C G, van den Bemt Bart J F, Bekker Charlotte L
Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands.
Explor Res Clin Soc Pharm. 2024 Aug 17;15:100493. doi: 10.1016/j.rcsop.2024.100493. eCollection 2024 Sep.
Minimizing medication waste through the redispensing of oral anticancer drugs (OADs) that were unused by patients provides economic and environmental benefits, but this is not yet universally implemented in clinical care.
To identify barriers and facilitators to the implementation of redispensing unused OADs in clinical care.
A multicentre intervention study following a hybrid effectiveness-implementation type I design was conducted, consisting of semi-structured interviews with key stakeholders involved in the redispensing program: pharmacy employees, prescribing clinicians in oncology and haematology, patients who participated in redispensing and patients who declined trial participation. Questions encompassed experiences and suggestions for future implementation. The Consolidated Framework for Implementation Research (CFIR) guided data collection and categorisation of identified barriers and facilitators through thematic analysis.
In total, 35 interviews were conducted, identifying 15 themes encompassing barriers and facilitators, reflecting all CFIR domains. Facilitators encompassed: 1) convenient process requiring an acceptable time-investment; 2) support from project leaders and implementation champions; 3) being well-motivated by personal values and societal impact; 4) feeling ensured of medication quality upon redispensing; 5) endorsement by healthcare providers for patient participation; 6) clear and personal patient communication; 7) good visibility of intervention successes; and 8) implementation well supported through a collaborative network. Barriers encompassed: 1) unclear target population; 2) redispensing legally prohibited; 3) absence of financial compensation for pharmacies; 4) complexity arising from two parallel work processes; 5) widespread communication on adjustments within local teams challenging; 6) patient's low receptiveness due to burden of oncology treatment; and 7) lack of familiarization among pharmacy technicians.
Facilitators for implementation of redispensing unused drugs mainly related to people's values, motivation, and societal demand, whereas barriers mainly encompassed practical issues, including knowledge, time, financial resources, and legal conditions. Strategies emphasizing the benefits of redispensing and further streamlining process compatibility could support implementation.
通过重新调配患者未使用的口服抗癌药物（OADs）来尽量减少药物浪费，具有经济和环境效益，但在临床护理中尚未普遍实施。
确定在临床护理中重新调配未使用的OADs的障碍和促进因素。
采用混合效果-实施I型设计进行多中心干预研究，包括对参与重新调配计划的关键利益相关者进行半结构化访谈：药房员工、肿瘤学和血液学方面的开方临床医生、参与重新调配的患者以及拒绝参与试验的患者。问题包括对未来实施的经验和建议。实施研究综合框架（CFIR）指导数据收集以及通过主题分析对已识别的障碍和促进因素进行分类。
共进行了35次访谈，确定了15个主题，涵盖障碍和促进因素，反映了CFIR的所有领域。促进因素包括：1）方便的流程，所需时间投入可接受；2）项目负责人和实施倡导者的支持；3）受个人价值观和社会影响的良好激励；4）重新调配时对药物质量有保障感；5）医疗保健提供者对患者参与的认可；6）清晰且个性化的患者沟通；7）干预成功的良好可见性；8）通过协作网络对实施的良好支持。障碍包括：1）目标人群不明确；2）法律禁止重新调配；3）药房缺乏经济补偿；4）两个并行工作流程产生的复杂性；5）在当地团队内就调整进行广泛沟通具有挑战性；6）患者因肿瘤治疗负担而接受度低；7）药房技术人员缺乏熟悉度。
重新调配未使用药物实施的促进因素主要与人们的价值观、动机和社会需求相关，而障碍主要包括实际问题，如知识、时间、财务资源和法律条件。强调重新调配的好处并进一步简化流程兼容性的策略可以支持实施。
