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Table 4 Factors that influenced the implementation and/or the perceived impact of local interdisciplinary meetings

From: Process evaluation of a complex intervention to optimize quality of prescribing in nursing homes (COME-ON study)

 Factors*ImplementationPerceived impactQuotes
InterventionThe interdisciplinary approach: requirement to gather a maximum of HCPs for the LIM
[Complexity of implementation process]
Barrier GP-F2: “The most difficult part of the local interdisciplinary meeting, perhaps, was finding a suitable moment for it. Because a larger number of physicians had to be present. I think that was the biggest problem, to arrange the agenda so everyone could attend.”
The overall workload of the COME-ON intervention
[Nature and characteristics]
Barrier CP-F3: “But I didn’t invite any GPs [since the workload was already so high for GPs in the COME-ON study]. It was the last step that I didn’t dare to take.”
Class of medication to be discussed
[Nature and characteristics]
 FacilitatorPH-W4: “It’s much easier to arrive at an idea, at a consensus with lipid-lowering drugs than with antidepressants, for many different reasons. In particular, because we have very objective criteria in the case of lipid-lowering drugs.”
  BarrierCP-F5: “There are a number of parameters for lipid-lowering drugs. But if you start to discuss the topic of antidepressants, there are so many factors involved that are not only pharmacological. When the parameters are much more difficult, it’s a bit guesswork for depression, it’s not so easy to distinguish.”
Material (i.e., summary of the evidence + topics to be debated) provided by the research team
[Nature and characteristics]
Facilitator GP-W2: “The PowerPoint presentation [a document provided by the research team with a summary of the key aspects and points to be discussed] was very helpful.”
 FacilitatorGP-F2: “I think that, with regard to the physicians, it is important that all those learning modules are available to refresh their knowledge. Especially from the discussions between the GPs at the beginning, for example, the first one was about statin use for those aged 65 and over. At the beginning of the conversation, there were ten different approaches, but we were still able to achieve a consensus at the end. If you did it without any preparation, I’m not sure whether drugs would be tapered so smoothly.”
Expert invited to contribute to the discussion
[Nature and characteristics]
 FacilitatorCP-W2: ”I think that Dr X [a geriatrician who was the invited expert], who came to the first local interdisciplinary meeting shared his experiences and encouraged people to think about things. /…/ It was very helpful.”
ProfessionalPerceived relevance or utility of LIM from a GPs’ point of view
[Attitudes to change]
Facilitator DIR-F2: “I also think we have a highly motivated group. I don’t remember whether it was the first or the second local interdisciplinary meeting, but there were GPs who said when they were leaving, ‘we should really do this again for other medication classes.’ That was a comment from a GP as he left after the local interdisciplinary meeting consultation.”
 Barrier PH-W6: “So [lack of perceived interest on the part of the GPs] we didn’t organize a second local interdisciplinary meeting. You had asked us [in accordance with the study protocol] to organize two local interdisciplinary meeting, but we didn’t feel they were interested in those meetings.”
  BarrierGP-W6: “In my opinion, the discussions were too theoretical and, well … Sometimes, it seems to me that it’s just empty talk.”
OrganizationImplementation of decisions taken during LIM
[Process and system]
 FacilitatorMCC-W2 : “What worked well was that, when we reached a consensus during the LIM, we knew the impact that it could have on the next ICC, on the follow-up of our patients.”
 BarrierHN-W1: “ /…/ It’s true, that’s what we decided [during the LIM about the appropriate use of antidepressants], we’re going to do it, we’re not doing it! /…/ But we had already forgotten, to some extent...”
Local aspect—between HCPs who already know each other
[Relationship]
 FacilitatorCP-W2: “The fact that it was local, people knew each other already, and everybody was taking part in the study, so we were all in the same boat…it wouldn’t have the same impact if the meetings [local interdisciplinary meetings] had been organized in Brussels with all the nursing homes /…/ in one big gathering.”
External contextInfluence and expectations of health authorities
[Policy]
 BarrierCP-W4: “We did feel that it was only about medications that are reimbursed. In my opinion, benzodiazepines should have been included too and not just antidepressants. We felt the INAMI [National Institute for Health and Disability Insurance] was behind that.”
FundingFacilitator GP-F2: “On a systemic basis, I think it could cause some problems without any remuneration.”
  1. CP: coordinating physician, DIR: directory board, F: Flanders, GP: general practitioner, HCPs: healthcare professionals, HN: head nurse, LIM: local interdisciplinary meeting, PH: pharmacist, W: Wallonia
  2. * According to the framework defined by Lau et al. [27]