# Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting—An implementation testing study

## TL;DR

This study tested a medication review service in Malaysian pharmacies using design thinking and implementation science to improve patient care and reduce drug-related problems.

## Contribution

The study introduces a tailored medication review service blueprint for Malaysian community pharmacies using design thinking and implementation science principles.

## Key findings

- 17 pharmacists piloted the service, with 78.5% reaching the testing phase and 36% reaching the implementation phase.
- Pharmacists identified 133 drug-related problems and provided 64 interventions, with most patients expressing satisfaction.
- Facilitation strategies like stakeholder engagement and training were critical for overcoming implementation barriers.

## Abstract

Medication review (MR) services are evidenced-based practices in which a systematic assessment of a patient’s medication is conducted, primarily aiming to optimize drug therapy and minimize adverse drug events through pharmacist interventions. Although studies show that MR services are effective, the implementation of MR services in Malaysia has been challenging due to several barriers. An MR services blueprint was developed to be adapted to the Malaysian community pharmacy setting as part of tailoring strategies.

Through utilizing the design thinking triple diamond model and implementation science principles, a powerful guide for healthcare researchers and stakeholders to assist with effective service implementation, this study aimed to evaluate the implementation testing and observe the effectiveness of the developed MR service blueprint.

The study utilizes an effectiveness-implementation Type 3 hybrid implementation science framework conducted from May 2021 to April 2022. Employing a qualitative ethnographic approach, researchers observed pharmacy study sites during the implementation of MR services. Both qualitative and quantitative data were collected across exploration, preparation, testing, and operational phases. Implementation outcomes evaluated include phases, reach, fidelity, acceptability, as well as implementation barriers and strategies. MR intervention outcomes included service characteristics and the number and type of drug-related problems and interventions offered.

17 community pharmacists were invited to pilot the MR service blueprint for six months in their setting. Of this, 78.5% (n = 11) of the pharmacies reached the testing phase, and 36% (n = 4) reached the implementation phase. Fifty-four patients were in the study, giving an implementation reach of 70%. The majority of surveyed patients expressed satisfaction with the service. The total DRP identified was 133, and 64 interventions were provided by the pharmacists. Facilitation strategies such as “Engage stakeholders by creating ownership of the change” and “Equip stakeholders with training” are needed to overcome the barriers.

This study marked the beginning of successful MR service implementation at Malaysian community pharmacies. Future studies with multi-level partnered strategies are required to reach full implementation and sustainability.