Adapting an Interprofessional Medication Adherence Program for Gout (IMAP‐Gout): A Theory‐Informed Pre‐Implementation Analysis Using the Theoretical Domains Framework (TDF)

INTRODUCTION: Adherence rates to urate lowering therapy in gout remain low. Successfully implemented in Switzerland, the Interprofessional Medication Adherence Program (IMAP) supports medication adherence through an ambulatory-based model of care that includes pharmacists, motivational interviewing, and electronic adherence monitoring. We aimed to determine the facilitators and barriers to implementing IMAP for patients with gout in a hospital in Australia. METHODS: Multi-stakeholder, semi-structured interviews were analyzed using the Theoretical Domains Framework (TDF) for each stakeholder group and Implementation Mapping was used to identify target behaviors. RESULTS: A total of 51 interviews were conducted with patients (n = 8), a general practitioner (n = 1), pharmacists (n = 8), rheumatologists (n = 21), nurses (n = 4), and decision/policy makers (n = 9). Patients identified their health-reducing gout flares and improving function-as key facilitators, while barriers included environmental context and resources, such as time constraints. Pharmacists and nurses were motivated by professional role and identity, particularly the opportunity to extend their skillsets. However, pharmacists faced barriers related to environmental context and resources, including insufficient funding or managerial support. Nurses were keen to improve their knowledge and skills, such as training in motivational interviewing. Rheumatologists were driven by their goals of improving patient outcomes, but expressed concerns about ensuring governance over a pharmacist-led program. For general practitioners, behaviors were facilitated by environmental context and resources, such as remuneration. Finally, decision/policy makers identified improving health system outcomes as key enablers, but emphasized the importance of program reach and cost-effectiveness. CONCLUSION: For successful implementation within our context, IMAP-Gout needs to be adapted from a pharmacist-led model to a nurse-led model.