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Table 4 Reported facilitators to acceptance of the pilot Therapeutic Drug Monitoring Advisory Service (the Service) aligned with the domains of the Theoretical Domains Framework (TDF)

From: Would they accept it? An interview study to identify barriers and facilitators to user acceptance of a prescribing advice service

TDF Domain

Reported facilitator

Supporting participant quotes

Had interacted with the Service

Had not interacted with the Service

‘Beliefs about Consequences’

Dose advice leads/will lead to better prescribing and better patient outcomes

“… you are covered by a system that’s already been put in place to protect the patients from your lack of knowledge” (P08, JMO)a

“You’d probably theoretically get better control of effective levels of vancomycin and better treatment of vancomycin-required therapies” (P05, Registrar)

Dose advice will reduce anxiety, improve confidence, and aid prescribing decisions

“I’m certainly imagining it will be helping prescribers and especially the junior doctors, who often aren’t confident, or not even confident with antibiotics as a whole.” (P19, Pharmacist)

“… it might be useful to have them [the Service] just to provide a bit of assistance in terms of dosing, in terms of therapeutic level” (P14, JMO)

Prescribing is/will be easier and/or more efficient with Service involvement

“… this process seems much more efficient because we don’t really have to redo the work, we’ve already got the data there … we just thought TDM Advisory group uses that data that is available to then give a more accurate result” (P06, Pharmacist)

“… anything that makes our job smoother and faster people would think is positive” (P04, JMO)

Dose advice reduces workload

“It saves time for prescribers in terms of dose adjustments, whether or not to review the guidelines and ‘um’ and ‘ah’ about what to do … the Service, it’s quite straightforward.” (P11, Pharmacist)

“I think it’ll be helpful if they’re able to order the samples for me” (P14, JMO)

Clinical teams will accept dose advice

“… getting that information to them [prescribers], they will change it [the dose].” (P06, Pharmacist)a

“We would probably just accept it anyways” (P13, Registrar)a

‘Environmental Context and Resources’

Communication

“I feel that at least a page or a phone call to the team to notify them that this vancomycin dose is way too much for this patient or way too subtherapeutic for a patient will at least help influence the time to change the dosing” (P11, Pharmacist)

“… if they wanna just adjust it, that’s fine, but it would always be good to have it communicated in some way as well, either written in the notes or someone call us …(P04, JMO)

Accessibility of dose advice

“… having that link [the dose report], means that not only I can access it, any one of the doctors or nurses who’re involved in the patient care have access to this information because it’s there when you sign into the patient’s results …” (P19, Pharmacist)

“… it needs to be somewhere that’s really easily accessible, otherwise it’s gonna get lost and people won’t even realise that it’s generated” (P10, JMO)

Resources

NR

“If it was like vastly outside of it, I’d need to look twice and I’d probably either speak to someone in clin [ical] pharm [acology] or look up like AMH or MIMS or whatever and see” (P18, Registrar)

‘Social Influences’

Service operators are vancomycin prescribing experts

“… the TDM Service are experts in therapeutic drug monitoring which is really important for vancomycin and getting the dose right..” (P03, JMO)

“… the way the hospital runs is different teams with different expertise provide input, so if the team with the vancomycin expertise provides input, you’d be silly to ignore it” (P10, JMO)

Social support

“… we had a patient that was on vancomycin. One of the doctors asked about what dose they were on, so I said, ‘It’s been modelled by the clin [ical] pharm [acology] team and they’re on this dose and that’s giving the appropriate levels’, so I said that to reassure them that it was correct, they were happy with it” (P15, Pharmacist)a

“I think something that would make me take the advice on board more willingly would be talking to the microbiologist over the phone so that at least you can flag what your concerns are and they’ll take that into consideration” (P16, Registrar)

‘Knowledge’

Knowledge of the existence of the Service

“… in pharmacy we’re informed of this Service, I assume they [the Service operators] would’ve done similar education or informed the prescribers in the hospital that this is available and is of benefit and to help guide practitioners in terms of dosages. So, just getting that message, and if they are aware of that, I’m sure doctors would refer to it” (P19, Pharmacist)

“… they [prescribers] then need to know that this [Service] exists” (P09, Registrar)

Scientific knowledge

“… if they [prescribers] understood the principles of why it’s recommended, then they would be more likely to adopt it” (P11, Pharmacist)

“I would take the opinion if it’s definitely evidence-based, 100% I would definitely do that. So if they [the Service operators] say that this is the recommended dose that you use for this person for this particular indication I’d definitely take that on board” (P16, Registrar)a

Procedural knowledge

NR

“I guess it’s just people knowing that that’s a change and that that’s where it is and knowing where to find it and then maybe I guess if you do that, you don’t need to speak to infectious diseases as often” (P20, Registrar)

‘Beliefs about Capabilities’

Dose advice increases/will increase professional confidence and comfort with vancomycin prescribing

“… and that [the dose report] kind of put me at ease seeing this has been considered. The software’s saying this, look at the progress notes and they kind of tally up and I’m more comfortable with that sort of dose.” (P19, Pharmacist)a

“… if we’re more confident about prescribing drugs that are perceived as sort of dangerous or uncommon for us, then we would also be more comfortable and that would be a very positive thing for us” (P04, JMO)

‘Memory, Attention and Decision Processes’

Understanding of vancomycin prescribing decision processes

NR

“… if they just tell me “drug level is low, please adjust”, then I probably will like something like that [the dose report] that will help me decide what the next dose should be.” (P14, Registrar)

  1. a Quote also aligns with a novel TDF domain, ‘Trust’
  2. AMH Australian Medicines Handbook, JMO Junior medical officer, MIMS Monthly Index of Medical Specialities, NR Nil report