Universität zu Köln

Soeling, Sara ORCID: 0000-0002-0752-358X, Koeberlein-Neu, Juliane, Mueller, Beate Sigrid, Dinh, Truc Sophia, Muth, Christiane, Pfaff, Holger ORCID: 0000-0001-9154-6575, Karbach, Ute, Kellermann-Muehlhoff, Petra and Kellermann-Muehlhoff, Petra (2020). From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy. Implement. Sci., 15 (1). LONDON: BMC. ISSN 1748-5908

Full text not available from this repository.

Abstract

Objective Formative evaluation of the implementation process for a digitally supported intervention in polypharmacy in Germany. Qualitative research was conducted within a cluster randomized controlled trial (C-RCT). It focused on understanding how the intervention influences behavior-related outcomes in the prescription and medication review process. Methods/setting Twenty-seven general practitioners (GPs) were included in the study in the two groups of the C-RCT, the intervention, and the wait list control group. Behavior-related outcomes were investigated using three-step data analysis (content analytic approach, documentary method, and design of a model of implementation pathways). Results Content analysis showed that physicians were more intensely aware of polypharmacy-related risks, described positive learning effects of the digital technology on their prescribing behavior, and perceived a change in communication with patients and pharmacists. Conversely, they felt uncertain about their own responsibility when prescribing. Three main dimensions were discovered which influenced adoption behavior: (1) the physicians' interpretation of the relevance of pharmaceutical knowledge provided by the intervention in changing decision-making situations in polypharmacy; (2) their medical code of ethics for clinical decision making in the context of progressing digitalization; and (3) their concepts of evidence-based medicine on the basis of professional experiences with polypharmacy in primary care settings. In our sample, both simple and complex pathways from sensitization to adoption were observed. The resulting model on adoption behavior includes a paradigmatic description of different pathways and a visualization of different observed levels and applied methodological approaches. We assumed that the GP habitus can weaken or strengthen interventional effects towards intervention uptake. This formative evaluation strategy is beneficial for the identification of behavior-related implementation barriers and facilitators. Conclusion Our analyses of the adoption behavior of a digitally supported intervention in polypharmacy revealed both simple and complex pathways from awareness to adoption, which may impact the implementation of the intervention and therefore, its effectiveness. Future consideration of adoption behavior in the planning and evaluation of digitally supported interventions may enhance uptake and support the interpretation of effects.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Soeling, Sara UNSPECIFIED orcid.org/0000-0002-0752-358X UNSPECIFIED Koeberlein-Neu, Juliane UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Beate Sigrid UNSPECIFIED UNSPECIFIED UNSPECIFIED Dinh, Truc Sophia UNSPECIFIED UNSPECIFIED UNSPECIFIED Muth, Christiane UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfaff, Holger UNSPECIFIED orcid.org/0000-0001-9154-6575 UNSPECIFIED Karbach, Ute UNSPECIFIED UNSPECIFIED UNSPECIFIED Kellermann-Muehlhoff, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED Kellermann-Muehlhoff, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-318696
DOI:	10.1186/s13012-020-01043-6
Journal or Publication Title:	Implement. Sci.
Volume:	15
Number:	1
Date:	2020
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1748-5908
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ADVERSE DRUG EVENTS; MEDICATION ERRORS; OLDER-PEOPLE; PRIMARY-CARE; TECHNOLOGY Multiple languages Health Care Sciences & Services; Health Policy & Services Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31869