A Scoping Review of Barriers and Facilitators to Implementation of Intravenous Cardiovascular Treatments in Ambulatory Settings

OBJECTIVES: Novel therapies are being developed to reduce the risk of cardiovascular death, myocardial infarction (MI), and stroke in the high-risk 90-day period following acute MI. However, the implementation of intravenous (IV) therapies in ambulatory care settings may be limited by multi-level barriers. This systematic scoping review aims to identify the barriers and facilitators influencing the implementation of current therapies.

METHODS: We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to September 2023 that reported barriers and/or facilitators of IV therapy uptake in ambulatory cardiovascular care. We conducted a thematic analysis to identify barriers and facilitators of IV therapy uptake.

RESULTS: Fifteen studies on IV therapies for cardiovascular conditions, primarily conducted in North America and Europe, met the eligibility criteria. Medication-level barriers of implementation included need for multiple vials and longer preparation time, while facilitators included evidence-based clinical indication. Patient-level barriers included adverse drug effects, difficult IV access or IV-related infections, anxiety, reduced mobility, non-adherence, and in the setting of home infusions, suboptimal home safety; facilitators included education and perceived comfort during care. Clinician-level barriers included concerns about medication safety profile, understaffing, and time constraints, while facilitators included clinician education and perceived utility of the IV therapy. Institutionally, staff/equipment shortages, liability concerns, and complex logistics for medication access and delivery were barriers, while guidance documents for IV therapy, safe settings, and available stock were facilitators. At the healthcare system level, financial constraints and limited services for care delivery were barriers, while favorable insurance policies as well as guidelines favoring the IV therapy were facilitators.

CONCLUSIONS: With a growing landscape of novel treatments requiring IV administration, understanding and addressing barriers and facilitators to IV modes of administration is crucial. Understanding these pre-emptively and addressing them has the potential to improve patient clinical outcomes and experience.