Adapting an Interprofessional Medication Adherence Program for Gout (IMAP-Gout): A Theory-Informed Pre-Implementation Analysis Using the Theoretical Domains Framework (TDF).
7 affiliations
- 1Rheumatology Department, Liverpool Hospital, Sydney, New South Wales, Australia.
- 2School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
- 3South West Sydney Campuses, School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia.
- 4Transdisciplinary School, University of Technology, Sydney, New South Wales, Australia.
- 5Liverpool Physiotherapy Department, SWSLHD, Liverpool, New South Wales, Australia.
- 6School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.
- 7Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.
Abstract
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.
Related
- Theoretical Frameworks in Medication Adherence Research: A Systematic Review Using the ABC Taxonomy.
- Medication Adherence Interventions for Older Adults: A National Mixed‐Methods Study of Implementation Across Italian Healthcare Settings
- Medication Adherence in Patients With Glaucoma and Determinants of Treatment Adherence: A Cross-Sectional Study
- Process evaluation of the INTENSE study aimed at improving adherence to oral diabetes and/or hypertension medication in people with type 2 diabetes
- Effectiveness of a pharmacy-led personalised intervention program aimed at improving adherence to oral diabetes and/or hypertension medication in people with type 2 diabetes
BibTeX
@article{tahir2026adapting,
title = {{Adapting an Interprofessional Medication Adherence Program for Gout (IMAP-Gout): A Theory-Informed Pre-Implementation Analysis Using the Theoretical Domains Framework (TDF).}},
author = {Fatima Tahir and Hossai Gul and Sacha Bossina and Fatima Rezae and David Martens and Helene Rickard and Ayano Kelly},
journal = {International journal of rheumatic diseases},
year = {2026},
month = oct,
doi = {10.1111/1756-185x.70928},
url = {https://europepmc.org/article/MED/42958606},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Adapting an Interprofessional Medication Adherence Program for Gout (IMAP-Gout): A Theory-Informed Pre-Implementation Analysis Using the Theoretical Domains Framework (TDF).
AU - Fatima Tahir
AU - Hossai Gul
AU - Sacha Bossina
AU - Fatima Rezae
AU - David Martens
AU - Helene Rickard
AU - Ayano Kelly
PY - 2026
DA - 2026/10/29
JO - International journal of rheumatic diseases
DO - 10.1111/1756-185x.70928
UR - https://europepmc.org/article/MED/42958606
AB - 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.
SN - 1756-1841
SN - 1756-185X
ER -