A theory-informed qualitative exploration of contextual and behavioural determinants for a pharmacist-led transition of care programme in the emergency department

BACKGROUND: Discharge from the emergency department (ED) to home often exposes patients to medication-related risks. Pharmacist-led interventions during this period may enhance medication safety and care continuity; however, successful implementation depends on understanding key behavioural and contextual determinants. AIM: To explore key stakeholders' perspectives on the barriers and facilitators to implementing a pharmacist-led transition of care (ToC) programme for patients discharged home from the ED, and to identify strategies to enhance its integration into practice. METHODS: A qualitative study using semi-structured interviews and focus group discussions with patients, clinical pharmacists, physicians, and nurses was conducted at a secondary care hospital. Participants were recruited using purposive and snowball sampling. Audio-recordings were transcribed verbatim, anonymized, and analysed using an inductive-deductive approach informed by the Theoretical Domains Framework (TDF) and the Care Transitions Framework (CTF). RESULTS: Twenty-three participants contributed to the study. Key barriers to implementation included limited awareness and confidence in pharmacists' roles in the ToC process, care coordination and interprofessional collaboration challenges, and system-level (e.g. workload, infrastructure limitations) and patient-related (e.g. patient capability and motivation, competing demands) constraints. Facilitators included: recognition of existing gaps in ED-ToC and appreciation of pharmacists' expertise. Critical enablers identified were stakeholder engagement, supportive infrastructure (e.g. leadership, resources), and adopting flexible, person-centred implementation approaches. CONCLUSIONS: Implementing a pharmacist-led ToC programme in ED is feasible but contingent on early stakeholder engagement, adequate resourcing, and clear workflows. Addressing identified contextual and behavioural barriers and leveraging facilitators are essential for successful implementation in real-world ED settings.