Implementation of a patient-centred complex intervention to improve Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care (the IMA-cRCT study): a mixed-methods process evaluation
Por:
Corral C, Sanchez A, Peñarrubia-María MT, Gil MM, Aznar I, Palma CM, Gallardo MC, Mari Carmen Olmos Palenzuela and Rubio-Valera M
Publicada:
8 jun 2025
Ahead of Print:
1 jun 2025
Resumen:
Introduction The initial medication adherence (IMA) intervention aims to improve adherence to cardiovascular disease (CVD) and diabetes treatments in primary care (PC) through standardised shared decision-making (SDM) and healthcare professional (HCP) collaboration (general practitioners (GPs), nurses and pharmacists). This study assessed the intervention's implementation (strategies, fidelity and integration into routine practice-based on the Normalisation Process Theory), mechanisms of action and the role of context. Methods The IMA-cRCT was an effectiveness-implementation cluster-Randomised Controlled Trial involving 24 Spanish PC centres (>300 HCP; >3000 patients) based on real-world evidence. This nested process evaluation used quantitative (monitoring data; HCP questionnaires) and qualitative methods (field diaries; 36 semistructured individual interviews and two focus groups (19 patients, 28 HCPs)). Quantitative data explored implementation and context and were analysed descriptively, while qualitative data examined implementation, mechanisms of action and context and were analysed using framework analysis. Both analyses were integrated for interpretation. Results Intervention implementation fidelity (6.5/10) and normalisation into clinical practice (7.6/10) were adequate, particularly regarding SDM and use of decision aids. HCPs recognised the importance of SDM, although some assumed it was already part of routine practice. The anticipated mechanisms of action were moderately supported. HCPs' knowledge and attitudes towards SDM improved as they acknowledged its relevance to practice. Some patients reported participation in decision-making, while others preferred the GP to decide on their behalf. Patients found leaflets helpful for understanding information. Contextual factors influencing the intervention were mainly organisational, such as lack of time and familiarity with SDM. Conclusions The interprofessional SDM-based IMA intervention was considered beneficial for patients and HCPs, with adequate implementation fidelity and normalisation into practice. The intervention was important for HCPs, and patients accepted it. However, greater effort is needed to extend SDM throughout healthcare, moving towards patient-centred care. These results have enhanced understanding of SDM interventions and support their refinement for future implementation. Trial registration number ClinicalTrials.gov, NCT05026775.
Filiaciones:
Corral C:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Madrid, Spain
Sanchez A:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Madrid, Spain
Department of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain
Peñarrubia-María MT:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Madrid, Spain
Primary Care Centre Bartomeu Fabrés Anglada, Primary Care Research Institute (IDIAP Jordi Gol), Catalan Institute of Health South Metropolitan Territory Management, Barcelona, Catalonia, Spain
Gil MM:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Catalonia, Spain
Aznar I:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Madrid, Spain
Palma CM:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Catalonia, Spain
Gallardo MC:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Primary Care Centre Bartomeu Fabrés Anglada, Primary Care Research Institute (IDIAP Jordi Gol), Catalan Institute of Health South Metropolitan Territory Management, Barcelona, Catalonia, Spain
Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Catalonia, Spain
Mari Carmen Olmos Palenzuela:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Primary Care Centre Bartomeu Fabrés Anglada, Primary Care Research Institute (IDIAP Jordi Gol), Catalan Institute of Health South Metropolitan Territory Management, Barcelona, Catalonia, Spain
Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Catalonia, Spain
Rubio-Valera M:
Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, St Boi de Llobregat, Catalonia, Spain
Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Madrid, Spain
Department of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain
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