Co-design of an intervention aimed to Activate pharmacists to review medication-related problems: The ACTMed co-design and pilot study

To co-design and pilot the use of an actionable and pharmacist-led medication safety dashboard with concurrent general practitioner feedback and economic incentives as a way of targeting serious medication related problems in the primary care setting. The intervention is called ACTMed. Activities to be undertaken during the pilot phase include: 1. Selection of clinical indicators - preliminary epidemiological work will be undertaken using Patron data to develop a list of clinical indicators that will drive the recall selection within the dashboard. The Patron dataset is a deidentified dataset of clinical records from general practice, collected and governed by The University of Melbourne (https://medicine.unimelb.edu.au/school-structure/general-practice/engagement/data-for-decisions). Use of this data is subject a separate ethics application to The University of Melbourne. 2. Development of Future Health Today (FHT) module to identify ‘at risk’ individuals - a software platform for general practice that streamlines the identification and management of at-risk consumers to support recall, follow-up and to provide decision support according to clinical best practice standards 3. Development of the MedAdvisor recording platform to record all actions of pharmacists and General Practitioners when undertaking the ACTMed intervention for patients flagged as high risk of serious medication-related problems. The Future Health Today platform was co-designed with general practitioners and is now a fully-mature software platform. The ACTMed module and MedAdvisor module will be co-designed with input from pharmacists and general practitioners. 4. Co-design of the ACTMed intervention with consumers - activities will include ‘Kitchen Table Discussions' led by trained facilitators from Health Consumers Queensland (HCQ), and First Nation’s-led Yarning Circles in community to identify consumer priorities, preferences and informational needs when interacting with health practitioners around their medicines. Kitchen Table Discussions and Yarning Circles will occur face-to-face or via teleconference, taking into consideration the wishes of hosts and participants, their location, and any restrictions due to the global pandemic. It is anticipated that five Kitchen Table Events (which may be extended up to 10 Events) and 1-2 Yarning Circles will be undertaken until data saturation is reached. Each Kitchen Table Event and Yarning Circle is expected to last around 1.5 hours. Five key questions will be asked of participants. Consumer participants will also be asked if they would like to audio record or video record a testimonial of their lived experience that they would like to share with the health practitioners co-designing the ACTMed intervention. Written consumer consent will be obtained. Yarning circles will be facilitated by a suitably qualified and respected Aboriginal and/or Torres Strait Islander person, in accordance with the preferences of the local governance group. Consumer interviews will be undertaken to gain a more nuanced understanding of consumers views on medicines safety, as well as the consumer experience of the intervention co-design process itself. These will be undertaken by an experienced pharmacist. Interviews will be undertaken either in person or via teleconference. 5. Co-design of the ACTMed intervention with health practitioners within a Primary Health Network (PHN) integrated care framework - Practitioners will be asked to work with researchers to design workflows and solutions that respect the consumer voice but acknowledge the resource contracts in which they practice. There are three components included in the health practitioner co-design process: 1. Design of revised workflow, following consultation with consumer participants 2. Design of the ACTMed dashboard and refinement of the clinical algorithm and 3. Practice-based workshops to refine the service and workflow to prepare for the pilot phase of the project. The selection of clinical indicators and development of the Future Health Today and MedAdvisor modules will be undertaken concurrently with the initial consumer engagement work. This work is expected to last around 5 months. The consumer/health practitioner iterative co-design process will then occur over a period of 3 months. Pilot Phase - to develop or adapt the aspects of the intervention to be trialled. The pilot phase expected to last 3 months. Three General Practices will be recruited to participate in the pilot: one from Brisbane South Primary Healthcare Network, one in Melbourne and one Aboriginal and Community Controlled Health Organization (ACCHO) in Queensland. A pharmacist at each site will be recruited on a part-time basis to work in the General Practice or ACCHO for the pilot phase. It is anticipated that the service is piloted for a period of three months, which will be revised based on interim findings with input from the Steering Committee. Results from the pilot study will be used to determine if the full trial will go ahead. This decision will be made in consultation with the Steering Committee. Data from the pilot study will not be included in the cluster randomised controlled trial.