Pharmacists' barriers and facilitators on implementing a post-discharge home visit.
Introducing a post-discharge community pharmacist home visit can secure continuity of care and prevent drug-related problems. Currently, this type of pharmaceutical care is not standard practice and implementation is challenging. Mapping the factors influencing the implementation of this new form of care is crucial to ensure successful embedding.



To explore which barriers and facilitators influence community pharmacists' adoption of a post-discharge home visit.



A mixed methods study was conducted with community pharmacists who had recently participated in a study that evaluated the effectiveness of a post-discharge home visit in identifying drug-related problems. Four focus groups were held guided by a topic guide based on the framework of Greenhalgh et al. After the focus groups, major barriers and facilitators were formulated into statements and presented to all participants in a scoring list to rank for relevance and feasibility in daily practice.



Twenty-two of the eligible 26 pharmacists participated in the focus groups. Twenty pharmacists (91%) returned the scoring list containing 21 statements. Most of these statements were perceived as both relevant and feasible by the responding pharmacists. A small number scored high on relevance but low on feasibility, making these potential important barriers to overcome for broad implementation. These were the necessity of dedicated time for performing pharmaceutical care, implementing the home visit in pharmacists' daily routine and an adequate reimbursement fee for the home visit.



The key to successful implementation of a post-discharge home visit may lay in two facilitators which are partly interrelated: changing daily routine and reimbursement. Reimbursement will be a strong incentive, but additional efforts will be needed to reprioritize daily routines.
Utrecht University of Applied Sciences, Research Group Process Innovations in Pharmaceutical Care, Utrecht, The Netherlands; Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; Zorggroep Almere, Outpatient Pharmacy "de Brug 24/7", Almere, The Netherlands. Electronic address: rensing@zorggroep-almere.nl.
Hendrik T
HT
Ensing
Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
Ellen S
ES
Koster
Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
Timothy A A
TAA
Sontoredjo
Utrecht University of Applied Sciences, Research Group Process Innovations in Pharmaceutical Care, Utrecht, The Netherlands.
Ad A
AA
van Dooren
Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
Marcel L
ML
Bouvy
D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services / Q000191:economics / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000191:economics / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration; D017144:Focus Groups; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D006792:House Calls / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement; D054539:Medication Therapy Management; D010351:Patient Discharge; D010595:Pharmacists / Q000191:economics / Q000458:organization & administration / Q000523:psychology; D024382:Professional Role; D013997:Time Factors; D016526:Workload
Community pharmacy; Continuity of care; Home visit; Implementation research; Mixed method research