Adoption, implementation, and maintenance
RECRUITMENT, PCP
To measure PCP adoption of the pMTM intervention, short annual confidential surveys will be administered to quantify adoption of the pMTM intervention and recommendations by clinical providers, as well satisfaction and time spent related to pMTM. The study team will pilot test and monitor surveys to identify potential problems that could result in missing responses. Providers will be encouraged to complete all items on the survey, informed of the negative impact of missing data on the research, and assured that their answers are completely confidential. Those who participate will receive a $10 gift card after completing each annual survey. We will calculate the percentage and representativeness of eligible providers involved in the pMTM intervention and attempt to collect reasons for declination if observed.Implementation fidelity will be evaluated through audio recording of a sample of visits from the intervention arm (pMTM visit and corresponding clinical visit) and the usual care arm (clinical visit). We will screen and recruit participants for recording of visits using permuted block randomization for a total of 100 audio-recorded encounters (50 encounters per arm). For in-person visits, study personnel will start the recorder and leave the room. The parent, child, or provider can stop recordings at any point. For telehealth-based pMTM study visits, audio recording will occur within the software. The audio-recorded clinical encounters will be used to compare whether the provider addresses pMTM-related components (medication review, optimizations, and action plan) during the clinical visits (binary outcome), and to estimate the time needed to implement the pMTM intervention or discuss medication-related issues (continuous outcome), focusing on differences between pMTM and usual care.To measure aims related to pMTM maintenance, we will conduct 15 qualitative interviews with consented providers at time points including the beginning, middle, and end of the trial, for a total of 45 interviews. To reduce bias, we will attempt to interview all providers at least once during the study period. We will also attempt to interview some providers (specifically the pharmacists) at > 1 time point to evaluate how their experience with pMTM changed over time. Qualitative interview guides will be pilot tested prior to use with study subjects. We will elicit providers’ perceptions of the feasibility, acceptability, and barriers/facilitators of the pMTM intervention. At the final time point, we will specifically focus on providers’ perceptions and intentions of sustaining the interventions following the completion of the trial. Providers who participate in an interview will receive a $50 gift card. Recruitment will discontinue if ongoing analysis (described below) reveals thematic saturation [Finally, to measure maintenance outcomes related to program replication costs, we will use time-driven activity-based costing approach to measure the cost related to implementation and maintenance of pMTM relative to usual care costs. Using best practices, we will develop process maps for patient/parent flow for both pMTM and usual care delivery and specify care activities and who (pharmacist, provider, other clinic staff) performs each activity [