The Identification of Medication Adherence Barriers Questionnaire intervention (IMAB-Qi): feasibility study to test IMAB-Qi delivery and trial processes in general practice
Cardiovascular, medication non-adherence, hypertension
All eligible patients in the IMAB-Qi practices will be offered the Identification of Medication Adherence Barriers Questionnaire intervention (IMAB-Qi). The IMAB-Qi comprises a validated 10-item questionnaire called the IMAB-Q. Each IMAB-Q item represents a potential barrier to a patient taking their medication as prescribed. Each IMAB-Q item is linked to several theory and evidence-based behaviour change techniques (BCTs) that HCPs may deliver to patients within the Medication Review (MR) to address the medication adherence barrier(s) diagnosed by their IMAB-Q responses. Patients will be invited to complete the IMAB-Q prior to their MR using the practice’s usual procedures for collecting information from patients. Health care professionals will review IMAB-Q responses prior to the MR consultation to establish whether the patient is experiencing any barrier(s) to medication adherence, and for identified barriers, HCPs and patients will work together to establish the patient’s medicines to which the barrier(s) relate. Directed by the IMAB-Q, together they will select a BCT to address the barrier(s), and the HCP will deliver it during the MR. For patients where no barriers are identified in the IMAB-Q, the MR will continue without any BCTs being delivered. It is usual practice for HCPs to follow up any patients for whom changes to their care are made during an MR, including delivery of medication adherence support. Therefore, patients who received a BCT in their MR will be followed up as per usual practice. These patients will be sent a repeat IMAB-Q to complete and return before the follow-up appointment. If the repeat IMAB-Q indicates that the barrier(s) have not been addressed, the patient and HCP will explore why and address accordingly (e.g., re-deliver the same BCT(s) or select and deliver alternative BCTs) during the follow-up. For any patients where no barriers were identified using the IMAB-Q, any follow-up would be decided by the HCP and patient. Cont
GP Practices: 1. Have a named clinician who is willing and appropriate to undertake principal investigator responsibility. 2. Suitably trained staff available and willing to set up the study at the site, identify and recruit patient participants and collect and enter data as per protocol. 3. A named person based at the site to support IMAB-Qi implementation of the intervention and staff to support this (intervention sites only). 4. HCPs (pharmacists, doctors, nurses and other team members) with prescribing rights who conduct non-disease-specific MR consultations, available during the recruitment period and willing to deliver IMAB-Qi within their MRs, participate in the study, and undertake the required research-related tasks. 5. Use either SystmOne or EMIS electronic health record system GP practice staff: Staff fulfilling the following criteria will be eligible: 1. The Principal Investigator 2. Staff involved with supporting IMAB-Qi adoption and implementation 3. Staff involved with setting-up and delivering research processes Healthcare professionals (HCPs) involved with IMAB-Qi delivery: HCPs fulfilling the following criteria will be eligible: 1. Have Prescribing rights 2. Conduct MR consultations 3. Willing to deliver IMAB-Qi within their MRs, participate in the study and undertake required research-related training and tasks GP practice patients: 1. Adults aged >=18 years 2. On the hypertension register 3. Current prescription for >=1 antihypertensive medicine(s) prescribed for hypertension for at least the past 4 weeks 4. Blood pressure exceeding their NICE guidelines target for hypertension** 4.1. Aged 18-79 years >=140/90 mm Hg in clinic or >= 135/85 using home blood pressure monitor 4.2. Aged >=80 years >=150/90 mm Hg in clinic or >= 145/85 using home blood pressure monitor 5. Due a MR during the planned study recruitment period **Confirmed after consent
GP practices: General practices with <5% of their patient population prescribed an antihypertensive medicines Healthcare professionals (HCPs) involved with IMAB-Qi delivery: Healthcare professionals who conduct only disease-specific medication reviews, e.g., annual diabetes reviews Patient participants: 1. Not self-administering their medications 2. Excepted from NICE guideline age-related blood pressure target because it is inappropriate, e.g., receiving end-of-life care, on maximal tolerated doses of medication, declined treatment 3. On the severe mental illness register (IMAB-Q is not validated in this population) 4. Deemed by the practice staff to lack capacity to understand the study and unable to make a decision regarding participating 5. Under the care of a secondary care HCP for treatment of hypertension 6. Pregnant, lactating or known to be planning pregnancy during the study