Implementation of pharmacists' services into the care trajectory of older adults with neurocognitive disorder in multidisciplinary primary care clinics: A mixed-methods study

Introduction: In Quebec, Canada, the "Alzheimer plan" encourages pharmacist participation in the care of older adults with neurocognitive disorders (NCDs) within multidisciplinary primary care clinics, known as Family Medicine Groups (FMGs). This study examined how these services were implemented from the perspective of physicians, nurses, and pharmacists. Methods: We conducted a convergent mixed-methods study combining cross-sectional questionnaires with semi-structured interviews across eight FMGs participating in a quasi-experimental project about the impact of pharmacists' activities on older adults' medication and well-being. Data collection and analysis were guided by the Normalization Process Theory and the Consolidated Framework for Implementation Research. A deductive thematic content analysis was carried out, using the five CFIR constructs as themes. Data from questionnaires were analyzed alongside interview data to gain a broader perspective on the implementation process. Results: Eighteen professionals (nine pharmacists, four physicians, five nurses) participated. From a quantitative perspective, pharmacists' integration was perceived positively: high agreement was reported regarding the intervention's potential value (90% pharmacists, 100% other professionals) and its adaptability (100% pharmacists, 80% other professionals). Also, 100% of physicians and nurses intended to continue to use pharmacists' services in the future. Qualitatively, facilitators included an easy-to-implement innovation (innovation characteristics), legislative changes (outer setting), the pharmacist's physical presence, strong interprofessional trust (inner setting), and proactive pharmacists' leadership (individuals) with regular team reminders (implementation process). Conversely, insufficient government funding (outer setting) and workload pressures were identified as primary barriers. Conclusions: Implementing pharmacist services for older adults with NCDs in FMGs is feasible and beneficial, improving workflow and team efficiency beyond NCD care. Strong interprofessional collaboration, effective communication, and clear role definition were key facilitators, while insufficient funding and workload pressures remain major challenges to implementation. Co-construction between primary care teams and decision-makers is essential to achieve successful scale-up.