The IMA intervention is a multidisciplinary intervention that involves GPs, nurses and pharmacists and promotes shared decision-making between the patient and professional at the time of a new prescription in primary care. A pilot study was carried out to assess the feasibility and acceptability of implementing the intervention in clinical practice. This study helped to identify strengths and weaknesses and refine the IMA intervention and its evaluation design prior to the definitive IMA-cRCT.
As part of the IMA-cRCT study, 24 primary care centres (PCC) in Catalonia (Spain) were randomly assigned to the intervention and control group, and community pharmacies in the catchment areas of the intervention PCC were invited to participate. Healthcare professionals in the intervention group were trained on the IMA intervention as well as they were provided with technical support tools. These professionals applied the intervention to all patients who receive a new prescription for cardiovascular disease or diabetes treatment. The follow-up period will last until September 2023 and all study variables will be collected from patient electronic health records. Effectiveness and short-term cost-effectiveness analyses will be conducted once the observation period is over. Long-term cost-effectiveness will be assessed using a predictive model constructed using data from all Catalan patients who had a new prescription for cardiovascular disease and diabetes treatments between 2012 and 2013.
Alongside the cRCT, a mixed-methods process evaluation including quantitative and qualitative methods was conducted to assess implementation and to explore professionals’ and patients’ experiences. Quantitative data collection methods included data extraction from the intervention operative records and professional feedback questionnaires, whereas qualitative data collection involved interviews and field diaries. Quantitative and qualitative data were analysed separately and triangulated to produce robust results.
From the beginning of this project, results have been disseminated, including those of the pilot study, the optimisation of the IMA intervention, and the protocols of the cRCT and process evaluation to scientific audiences and decision-makers and managers of the Catalan Health System. In the last months, the preliminary results of the implementation process and professionals’ and patients’ experiences have been disseminated to scientific audiences as well as decision-makers of the Catalan Health System.
All the tasks were completed in the expected timing, with the exception of the field work, that was delayed 3 months due to the COVID-19 pandemic (as described in section ‘Technical challenges’).
