Factors Determining the Rate of Adoption of Pharmaceutical Recommendations by Patients in Primary Care Following a Medication Review by a Pharmacist

Polypharmacy represents a major public health issue, particularly among patients with chronic conditions, and is associated with increased risks of adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalizations. Medication reviews (MedRev), defined as structured and systematic evaluations of a patient's medication regimen, aim to optimize medication use, improve adherence, and enhance clinical outcomes.

In Belgium, a reimbursed medication review service has been implemented in community pharmacies since April 2023, promoting collaboration between community pharmacists (CPs) and general practitioners (GPs). However, while such interventions generate pharmaceutical recommendations, their real-world implementation remains variable and insufficiently understood. Previous studies suggest that contextual factors, particularly related to interprofessional collaboration and communication, play a key role in determining whether recommendations are effectively adopted.

The RevMedAdopt Pharmacy Study is a national prospective interventional study designed to evaluate the implementation of this MedRev service in real-life conditions. The study is embedded within the clinical training of final-year pharmacy students, who perform medication reviews under the supervision of accredited community pharmacists.

The primary objective is to assess the adoption rate of pharmaceutical recommendations issued following medication reviews. Adoption is defined as the extent to which recommendations are implemented in the patient's medication regimen and is categorized as fully adopted, partially adopted (alternative action taken), not adopted, or unavailable. This outcome is measured at two time points: 3 months after the intervention (via patient follow-up) and 6 months after the intervention (via GP follow-up).

Secondary objectives are to identify and assess contextual factors associated with the successful implementation of recommendations. These factors include patient-related characteristics (e.g., socio-demographic profile, comorbidities, medication burden), pharmacist-related aspects (e.g., supervision, role as reference pharmacist), GP-related aspects (e.g., involvement, collaboration with pharmacists), characteristics of the medication review process (e.g., access to clinical data, communication channels), and characteristics of the recommendations themselves (e.g., type and clinical relevance).