Trial reportBMC primary care2023
Complex implementation mechanisms in primary care: do physicians' beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study.
Trial report in BMC primary care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03430336 (Effectiveness and Cost-effectiveness of the Application of an Electronic Medication Management Support System in Patients With Polypharmacy in General Practice), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effectiveness and Cost-effectiveness of the Application of an Electronic Medication Management Support System in Patients With Polypharmacy in General Practice (AdAM).
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.
- Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review.Implementation science : IS · 2024Pooled it
- Patterns of CDSS adoption in primary care: a cluster analysis and predictive modelling study from a stepped wedge trial.Implementation science : IS · 2026Trial
- Logic Models on Health Information Technology-Related Interventions: Scoping Review Across Disciplines.JMIR medical informatics · 2026Article
- Adoption and sustainability of a virtual interprofessional team for primary care in Ontario: a qualitative study.BMC primary care · 2026Article
- Physicians' expectations of the use of conversational agents in healthcare: a qualitative study.BMC health services research · 2026Article
- Do process evaluations open up the 'black box' of implementation interventions in health care? A scoping review.Implementation science : IS · 2025Article
- Enhancing Diagnostic Infrastructure Through Innovation-Driven Technological Capacity in Healthcare.Healthcare (Basel, Switzerland) · 2025Article
- Differences in changes of data completeness after the implementation of an electronic medical record in three surgical departments of a German hospital-a longitudinal comparative document analysis.BMC medical informatics and decision making · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe adoption of digital health technologies can improve the quality of care for polypharmacy patients, if the underlying complex implementation mechanisms are better understood. Context effects play a critical role in relation to implementation mechanisms. In primary care research, evidence on the effects of context in the adoption of digital innovation for polypharmacy management is lacking. STUDY
aimThis study aims to identify contextual factors relevant to physician behavior and how they might mediate the adoption process.
methodsThe physicians who participated in this formative evaluation study (n = 218) were part of the intervention group in a cluster-randomized controlled trial (AdAM). The intervention group implemented a digital innovation for clinical decision making in polypharmacy. A three-step methodological approach was used: (1) a realist inquiry approach, which involves the description of a context-mechanism-outcome configuration for the primary care setting; (2) a belief elicitation approach, which involves qualitative content analysis and the development of a quantitative latent contextualized scale; and (3) a mediation analysis using structural equation modeling (SEM) based on quantitative survey data from physicians to assess the mediating role of the contextualized scale (n = 179).
resultsThe key dimensions of a (1) context-mechanism-outcome model were mapped and refined. A (2) latent construct of the physicians' innovation beliefs related to the effectiveness of polypharmacy management practices was identified. Innovation beliefs play a (3) mediating role between the organizational readiness to implement change (p < 0.01) and the desired behavioral intent of physicians to adopt digital innovation (p < 0.01; R
conclusionPhysician adoption is directly affected by the readiness of primary care organizations for the implementation of change. In addition, the mediation analysis revealed that this relationship is indirectly influenced by primary care physicians' beliefs regarding the effectiveness of digital innovation. Both individual physician beliefs and practice organizational capacity could be equally prioritized in developing implementation strategies. The methodological approach used is suitable for the evaluation of complex implementation mechanisms. It has been proven to be an advantageous approach for formative evaluation.
trial registrationNCT03430336 . First registration: 12/02/2018. CLINICALTRIALS: gov.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.