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Scientific article
Open access
English

A mixed methods analysis of the medication review intervention centered around the use of the Systematic Tool to Reduce Inappropriate Prescribing Assistant (STRIPA) in Swiss primary care practices

Published inBMC health services research, vol. 24, no. 1
Publication date2024
First online date2024-03-18
Abstract

Background. Electronic clinical decision support systems (eCDSS), such as the ‘Systematic Tool to Reduce Inappropriate Prescribing’ Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the ‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) trial.

Methods. We used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs ( n = 21) and their patients ( n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group ( n = 8), and interview data were analyzed through thematic analysis.

Results. In quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations.

Conclusions. Qualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs’ overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports).

Trial registration. Clinicaltrials.gov NCT03724539, date of first registration: 29/10/2018

eng
Keywords
  • Electronic clinical decision support system
  • Medication optimization
  • Mixed methods research
  • Multimorbidity
  • Polypharmacy
  • Primary care
Citation (ISO format)
JUNGO, Katharina et al. A mixed methods analysis of the medication review intervention centered around the use of the Systematic Tool to Reduce Inappropriate Prescribing Assistant (STRIPA) in Swiss primary care practices. In: BMC health services research, 2024, vol. 24, n° 1. doi: 10.1186/s12913-024-10773-y
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ISSN of the journal1472-6963
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