Abstract
Background: Approximately 50% of the population in North America have taken a prescription medication in the past 30 days. Despite the high use of prescription medications, formal measures to capture medication-related experiences (i.e., patient-reported experience measures; PREMs) are not routinely used in clinical practice. Measuring and optimizing patient experiences are of critical importance to ensuring value-based care. The aim of this study was to explore what barriers and facilitators influence the implementation and use of PREMs for medications in primary healthcare.
Approach: We undertook a theory-based, qualitative study informed by an advisory council consisting of five persons with lived experience (PWLE). Semi-structured interviews and focus groups were conducted with three key stakeholder groups: PWLE, medication prescribers (e.g., physicians, pharmacists, nurses), and health system decision-makers in Ontario, Canada. Interview guides were structured based on constructs from two established frameworks, the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using rapid deductive directed content analysis.
Results: We recruited 50 participants, including 21 PWLE, 20 medication prescribers, and 9 decision-makers. A number of key barriers and facilitators from the TDF were reported by participants. For example, most PWLE did not have experience completing a PREM about their medications and reported that they often had to initiate the conversation with their prescribers (TDF domain: Knowledge). Prescribers described using informal processes to capture their patients’ experiences with medications, rather than standardized questions. Participants reflected on several skills needed for reporting medication-related experiences, including: self-advocacy, communication, and knowledge and awareness (Skills). Most PWLE felt that reporting their experiences with medications was important and both prescribers and decision-makers were optimistic that routine use of PREMs could improve patient experiences and outcomes (Optimism). However, all participant groups reflected on significant barriers to PREM-Rx including: lack of resources, staff burnout, language and cultural barriers, fear of negative repercussions on care, and lack of staff and patient education (Emotion, Beliefs about Consequences, Environmental Context and Resources). Despite these barriers, participants brainstormed solutions to address these challenges, which included: staff and patient training and education, use of technology to support seamless integration into practice, and access to standardized forms (Environmental Context and Resources, Behavioural Regulation). Decision-makers also discussed the importance of financial incentives for staff to support implementation (Reinforcement). Overall, participants discussed the need for more information on where and how to report experiences related to medications and the potential benefit of structured prompts to guide the conversation (Knowledge).
Implications: We have identified barriers and facilitators to the use of PREMs for medications among key stakeholders in primary healthcare. Assessing what matters most to PWLE when discussing medications and understanding the clinical context in which such conversations take place has the potential to improve medication-related experiences, outcomes, and integrated health service delivery. Next steps for this work include a quantitative survey to further quantify barriers and facilitators to the use of PREMs for medications. Ultimately, this project will help inform the development, evaluation, and implementation of PREMs for medications in primary healthcare.