From sensitization to adoption? A qualitative study of the implementation of a digitally supported intervention for clinical decision making in polypharmacy
Authors: Söling Sara , Köberlein-Neu Juliane , Müller Beate Sigrid , Dinh Truc Sophia , Muth Christiane , Pfaff Holger , Karbach Ute ,   AdAM Study Group, Kellermann-Mühlhoff Petra , Düvel Lara , Beckmann Till , Hammerschmidt Reinhard , Jachmich Julia , Leicher Eva , Brandt Benjamin , Richard Johanna , Meyer Frank , Flume Mathias , Müller Thomas , Gerlach Ferdinand M. , Gonzalez-Gonzalez Ana Isabel , Chapidi Kiran , Brünn Robin , Ihle Peter , Meyer Ingo , Timmesfeld Nina , Trampisch Hans J. , Klaaßen-Mielke Renate , Basten Jale , Greiner Wolfgang , Suhrmann Bastian , Piotrowski Alexandra , Beifuß Karolina , Meyer Sarah , Grandt Daniel , Grandt Simone 
Published: September 2020

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.

Trial registration

NCT03430336, 12 February 2018.