(1333) Comparison of Expected and Experienced Barriers and Facilitators to Implementation of a Digital Health Intervention in Community Pharmacies

Objectives: Our team recently conducted a pre-implementation formative evaluation to identify expected barriers and facilitators to implementation of a digital heath intervention (PatientTocTM) utilized to capture patient-reported outcomes related to medication adherence in community pharmacies. Using this information, our team then piloted the use of PatientTocTM in three pharmacies located in Indiana, Minnesota, and Wisconsin. During the pilot period, we collected experienced barriers and facilitators to implementation. This study objective was to explore to what extent expected barriers and facilitators aligned with experienced barriers and facilitators.

Methods: This study was a descriptive review of findings from both the pre-implementation (collection of expected barriers and facilitators) and pilot PatientTocTM implementation (collection of experienced barriers and facilitators) phases to identify areas of alignment or misalignment. Participating pharmacies for both the pre-implementation and pilot implementation phases were recruited through state-wide pharmacy practice-based research networks in Indiana, Minnesota, and Wisconsin. In both phases, data collection included audio-recorded semi-structured interviews and study team observations. In the pre-implementation phase, interview guides were informed by the Consolidated Framework for Implementation Research (CFIR) and transcripts were coded utilizing a hybrid deductive/inductive approach also guided by the CFIR to identify expected barriers and facilitators to implementation of PatientTocTM. In the pilot implementation phase, interview guides were informed by implementation outcomes as described by Proctor: adoption (i.e., frequency of PatientToc™ use), appropriateness (i.e., perceived “fit” in pharmacy), acceptability (i.e., satisfaction with use), feasibility (i.e., ability to use within pharmacy’s workflow), and fidelity (i.e., extent PatientToc™ was used as planned). Interview transcripts were coded utilizing a deductive approach guided by Proctor’s implementation outcomes. Observation note templates were also mapped to CFIR and implementation outcomes, respectively, and provided further context when analyzing interview data. Two researchers then reviewed interview and observation data from the pre- and pilot-implementation phases to identify areas of alignment and misalignment in expected vs. experienced barriers and facilitators.

Results: All experienced barriers aligned and all but one of the experienced facilitators aligned with our initial expectations. The four barriers included: (1) concerns regarding the lack of existing integration amongst technology vendors (e.g., pharmacy dispensing software systems and PatientToc™), (2) potential resistance to using PatientToc™ among sub-groups of patients (e.g., those resistant to using technology), (3) difficulties implementing PatientToc™ due to staffing, space, and communication concerns, and (4) data security concerns amongst both pharmacy staff and patients which could limit uptake. The three aligned facilitators included: (1) pharmacy teams’ willingness to try new things with the goal of improving patient care, (2) strong communication amongst staff and pharmacy leadership, and (3) perceived ease of use of PatientToc™ by patients and pharmacy staff with minimal training requirements. However, while our pre-implementation results suggested that PatientToc™’s focus on measures of importance to community pharmacy teams (e.g., Centers for Medicare and Medicaid Services STAR Quality Ratings, medication adherence) would also facilitate implementation, this was not observed in the pilot implementation.

Conclusions: Most experienced barriers and facilitators aligned with those that were expected from our pre-implementation findings. This highlights the effectiveness of pre-implementation research in accurately identifying important barriers and facilitators when planning community pharmacy interventions. Further research is needed to determine best practices for mitigating barriers and leveraging facilitators for further scale of PatientToc™ and other digital health interventions in community pharmacies.