Implementation and scalability of primary care interventions to improve patients medication use: bridging research and practice

Treatment with medicines is the single most used method for treating patients with chronic conditions and to prevent further damage of the disease. The use of medicines is agreed upon between healthcare provider and patient and is only effective if used correctly. However, medication use is problematic for many patients and drug-related problems are common when patients do not succeed in following their treatment. Non-adherence to treatment regimens is a major drug-related problem in 44 to 77% of chronic medication users. Many evidence-based medication adherence interventions have been developed for healthcare providers to better support patients in taking their medication. These interventions are often complex, as they must be tailored to diverse patient populations, rely on close collaboration between different healthcare providers, and require continuous monitoring of non-adherent patients. This complexity means that for these interventions to be effective, they must be continuously available for patients by a multidisciplinary team of healthcare providers. As such, they need to be fully integrated into daily clinical practice systems in a (cost-)effective manner. However, so far, their implementation is often lacking. Integrating complex interventions into daily clinical practice is complex. It requires tailoring the intervention to the context in which they will be implemented, which requires using implementation strategies that fit within the context. In order to do so, detailed information about the setting and its context is required. However, current publications on interventions generally do not provide sufficient details about the implementation and the context to be reproduced in different settings. This tailoring can be supported by dissemination and implementation science methods, which offer different models and theories on implementing complex interventions into daily clinical practice. Throughout this thesis, we provide insight into how medication use of patients with a chronic disease can be optimized by improving the implementation and scale-up of medication adherence interventions in primary care. This was described in five chapters (chapters 2 to 6). We discussed our main findings and drew conclusions in chapter 7.