Integrating clinical pharmacists into transitions of care: A qualitative study of barriers and facilitators among federally qualified health centers

Background: Comprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health-related goals. Objective: The objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs). Design: Semistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC. Key Results: Thirty-nine codes were identified across all CFIR constructs, including the addition of a new construct, "Patient characteristics." Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy-in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput. Conclusions: Identifying early-stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes.