Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review

Abstract

Background: Several guidelines support polypharmacy management in individual patients. More organisational-level focus is needed on the use of implementation frameworks. Aim: To characterise the peer reviewed literature on implementation frameworks, focussing on barriers and facilitators to implementation at organisational level in the context of polypharmacy management. Method: A scoping review protocol was devised, supporting retrieval of studies published in English, reporting from any sector of practice. Medline, International Pharmaceutical Abstracts, Cumulative Index of Nursing and Allied Health Literature and Business Source Complete were searched to January 2022 using Medical Subject Headings including: ‘polypharmacy’, ‘deprescriptions’, ‘strategic planning’ and ‘organizational innovation’. A narrative approach to data synthesis was applied. Searching, data extraction and synthesis were undertaken independently by two reviewers. Results: After screening 797 records eight papers remained. Two were descriptive outlining details of specific initiatives, six used qualitative methods to explore determinants for implementation including barriers and enablers. Organisation level barriers included: poor organisational culture with a lack of sense of urgency and national plans, resource availability and communication issues including patient information and at transitions of care. Organisational facilitators included availability of government funding and regulatory environment promoting patient safety, a national emphasis on quality of care for older adults, co-ordinated national efforts and local evidence. Conclusion: Limited literature focusses on the use of implementation frameworks at organisational levels. This review highlights the need for further work on implementation frameworks in this context to help achieve effective organisational change.