Assessing Implementation Fidelity Of An On-site Pharmacist Intervention Within Australian Residential Aged Care Facilities: A Mixed Methods Study

• By: BATTEN, Miranda (University Of Canberra, Australia)
• Co-author(s): Ms Miranda Batten (University Of Canberra, Canberra, Australia)
  Dr Jane Koerner (University Of Canberra, Canberra, Australia)
  Associate Professor Sam Kosari (University Of Canberra, Canberra, Australia)
  Professor Mark Naunton (University Of Canberra, Canberra, Australia)
  Associate Professor Joanne Lewis (Avondale University, Sydney, Australia)
  Professor Karen Strickland (Edith Cowan University, Perth, Australia)
  
• Abstract:

  Background: An on-site pharmacist (OSP) intervention was implemented in 7 residential aged care facilities (RACFs) in Australia as part of a cluster randomised controlled trial (cRCT) to improve medication management. Implementation fidelity, defined as the extent to which an intervention was delivered as intended, has been sparsely reported within the peer-reviewed international literature evaluating pharmacist interventions conducted in real world RACFs.
  Purpose: This mixed methods study evaluated the implementation fidelity of the OSP intervention within the context of a cRCT and determined the moderating factors which influenced delivery of this intervention.
  Method: This convergent parallel mixed methods study was underpinned by Hasson’s conceptual framework for implementation fidelity. Implementation fidelity for 7 intervention RACFs was quantitatively assessed using 3 quantitative data sets: (1) range of OSP intervention activities delivered; (2) random sample of 10% of medication reviews assessed for quality; (3) proportion of residents who received at least one medication review. Semi-structured interviews with RACF managers (n= 8) and OSPs (n= 6) across the intervention RACFs were conducted to identify moderating factors which may have influenced OSP intervention delivery. Qualitative data was analysed using framework analysis with themes deductively derived based upon Hasson’s conceptual framework for implementation fidelity.
  Results: The OSP intervention was generally delivered as intended with overall medium levels of implementation fidelity. Delivery was supported by a range of facilitation strategies with most participants perceiving that the intervention was delivered to a high standard. RACF managers and OSPs were mostly well engaged and responsive. A number of potential barriers (including the part-time OSP role, COVID-19 pandemic, RACFs spread out over a large area with significant distance between resident dwellings) and facilitators (including the pharmacist support meetings, OSPs who took time to establish relationships, RACF managers who actively supported OSPs and worked with them) for OSP intervention delivery were identified.
  Conclusion: In this study, the implementation fidelity of OSP intervention delivery was assessed with overall medium levels of fidelity found across the intervention RACFs. This suggested that the OSP intervention can generally be delivered as intended in real world RACFs. OSP intervention delivery was influenced by a range of moderating factors, some of which posed barriers and others which facilitated the OSP intervention being delivered as intended.