Mapping the Theoretical Domain Framework to the Consolidated Framework for Implementation Research: do multiple frameworks add value?

BACKGROUND

Implementation researchers often combine the Theoretical Domain Framework (TDF) and Consolidated Framework for Implementation Research (CFIR) in their studies. However there is some debate on the merits of using multiple frameworks-whether they contribute to results or provide superfluous analysis. Our recent research combined the TDF and CFIR to identify determinants to widespread incorporation of patient held medication lists (PHML) in healthcare practice. The aim of this report is to provide guidance on the use of the TDF and CFIR; by assessing the degree of overlap between the two frameworks in their application to interviews about PHML.

METHODS

Semi-structured telephone interviews were conducted with healthcare professionals (HCPs) and non HCPs (people taking multiple medicines and caregivers).Interview data were transcribed and analysed using the TDF and CFIR. Within paired domains substantial intersection/overlap across constructs and domains within the two frameworks was classified as > 75% of coding references, consistent intersection/overlap was defined as > 50% and ≤ 75%, average intersection/overlap was defined as ≤ 50% and > 25% and non-substantial intersection/overlap was classified as ≤ 25% of coding references.

RESULTS

Interview data were collected from 39 participants - 21 HCPs and 18 non HCPs. Mapping of TDF domains to CFIR domains/constructs identified key determinants in six TDF domains: Environmental context & resources, Beliefs about capabilities, Beliefs about consequences, Social influences, Behavioural regulation and Social/professional role & identity; and five CFIR domains: Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individual and Process. A pattern of substantial intersection/overlap in coding emerged with broad TDF domains such as Environmental context & resources often linked to well-defined CFIR domains and constructs (e.g. design quality & packaging within Intervention Characteristics). Broad CFIR constructs such as knowledge & beliefs about intervention within Characteristics of Individuals also linked to more descriptive TDF domains like Beliefs about capabilities. In addition there was some unexpected non-substantial intersection/overlap in coding with the TDF domain Social influences less frequently linked to the CFIR Inner Setting domain and constructs such as networks and communications.

CONCLUSIONS

Identifying intersections/overlaps in coding between CFIR and TDF can assist interpretation of findings in implementation research. The strengths of each framework were exploited in a reciprocal process which provided more information to broad/poorly defined domains and enabled identification of implementation determinants and innovation determinants.

145 ASSESSING MEDICINE LISTS: A QUALITATIVE STUDY WITH MULTIPLE STAKEHOLDERS

Background

Multimorbidity and polypharmacy often result in numerous interactions with different Healthcare Professionals (HCPs) and many transitions of care. Keeping up-to-date medications list in people taking medicines and/or carers can reduce medication errors at care transitions. The HSE National Quality Improvement team is working on a national medication safety campaign which encourages people to keep lists. However, there is limited information about perceptions of Patient-Held Medication Lists (PHML) in clinical practice. The aim of this study was to examine attitudes to PHML among people taking/managing multiple medicines, HCPs; and how lists are used in practice.

Methods

Purposive sampling was employed and recruitment through relevant organisations, social media and snowballing methods. Semi-structured telephone interviews were conducted with 39 people; HCPs (N=21), patients/caregivers (N=18). Interviews were transcribed and thematically analysed with behavioural frameworks - the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF).

Results

Three core themes were identified: Attitudes to PHML; Function and preferred features of PHML and Barriers and facilitators to future use of PHML. All participants thought keeping medication lists had benefits for both people and HCPs (e.g. empowering, improving adherence). All who were taking medicines used lists and found them useful in particular situations (e.g. emergencies). However, HCPs and patient/caregiver groups expressed concerns about their accuracy. It was felt that some individuals may have difficulties keeping an accurate PHML (e.g. older adults, on multiple/changing medications). The participants also differed on the level of detail that should be included in PHMLs. Most patients favoured simple lists but HCPs reported the lack of detailed information in PHML may be an issue.

Conclusion

Common concerns about the accuracy of PHML and diverging opinions on list content need to be addressed. Health promotion strategies which focus on promotion of lists by key HCPs and provide people with a variety of list options could increase the wider implementation of PHMLs.

40 PREVALENCE OF DRUG-DRUG INTERACTIONS IN OLDER COMMUNITY-DWELLERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Polypharmacy (regular use of ≥5 medicines) is common in the older population and is an independent risk factor for Drug-Drug Interactions (DDIs). We conducted a systematic review and meta-analysis to summarise the prevalence of DDIs in older (≥65years) community-dwellers.

Methods

An electronic database search was conducted in PubMed and EMBASE. Observational studies published in English between 01/01/2010-10/05/2021 reporting DDI prevalence in community-dwellers aged ≥65years were included. Nursing home and inpatient hospital studies were excluded. Articles were independently double screened for eligibility. Data were independently extracted, 20% extracted in duplicate. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tool. Prevalence estimates and 95% confidence intervals (CI) are presented. All analyses were performed using the metafor package(v3.0.2) in R(v4.1.2). (PROSPERO:CRD42020216686).

Results

5144 unique articles were identified. 33 studies involving 17,011,291 community-dwellers aged ≥65years (age range 65-103) met inclusion criteria. 22 studies measured DDIs broadly classified as (potentially) clinically important. DDI identification methods varied across studies: 5 used Micromedex®; 3 used the 2015 AGS Beers criteria®; 3 used Lexi-Interact®; 2 used drugs.com; 6 used multiple methods; and 14 used a unique method. 31 studies reported DDI prevalence at the study participant level; estimates ranged from 0.8% to 90.6%. 26 studies were qualitatively synthesised and 7 studies were eligible for meta-analyses. In a meta-analysis of 3 studies (n=1122) using Micromedex®, DDI prevalence in older (≥65years) community-dwellers was estimated to be 57.8% (95%CI: 52.2-63.2%; I2 69.6%, p<0.01). In a meta-analysis of 2 studies (n=809,113) using Lexi-Interact®, the estimated prevalence was 30.3% (95%CI: 30.2-30.4%; I2 6.8%). In a meta-analysis of 2 studies (n=947) using the 2015 AGS Beers criteria®, the estimated prevalence was 16.6% (95%CI: 5.6-40.2%; I2 97.5%, p<0.01).

Conclusion

DDIs are prevalent among older community-dwellers; however, the methodology used to estimate these events varies considerably. A standardised method is needed to allow meaningful measurement of DDI prevalence in this population.