Table 4

Mechanisms influencing outcomes

1. Mandate	HCPs have a mandate to recruit patients to MR, for example, in hospitals or community pharmacy. Pharmacists are given a mandate through regulation and funding and perceive they have a mandate to perform MR by patients and other HCPs.
2. Effort required	Effort any participant has to make to obtain information to organise or participate in the MR process, for example, patients to organise appointments, pharmacists to recruit and organise, doctors to refer.
3. Trust in HCPs	Patients trust a referral by a doctor or hospital staff and trust the pharmacist performing MR.
4. Recognition of pharmacists’ clinical and professional role	Pharmacists’ competence and skill to perform MR is recognised by pharmacists themselves, other HCPs and patients.
5. Perception of benefit from MR by HCPs and patients	Patients and HCPs perceptions of benefit from an MR influences their willingness to participate in, refer to or conduct an MR.
6. Patient preference	Accessibility (6a), acceptability (6b) and convenience (6c) of location and time for MR and who performs it (un/familiar pharmacist) (6d).
7. Prioritisation of health and social care needs	Patients balance the benefit of MR against other priorities and commitments. MR is not always a priority for patients after leaving hospital.
8. Invitation to collaborate	Pharmacists personally communicate with or contact doctors about MR, doctors refer patients to pharmacists, inviting each other to collaborate.
9. Potential to employ clinical skill	Pharmacists are enabled to employ their clinical skills and judgement.
10. Taking responsibility	Pharmacists take responsibility for MR outcomes, resolving the issues they can or take responsibility to get the ones who can to resolve them. HCPs take responsibility for recruiting patients to MR.

HCP, healthcare professional; MR, medication reviews.