Eliciting key stakeholders’ perceptions of the barriers and suggested solutions towards implementing direct healthcare professional communications (DHPCs) in practice using one-to-one semi-structured interviews

Abstract Introduction Direct healthcare professional communications (DHPCs) are vital patient safety measures sent by marketing authorisation holders to healthcare professionals to inform them of important new safety information about a medicine and actions they should take. However, their effectiveness is variable. A 2025 systematic review of 31 European DHPCs issued between 2008–2022 found that only 29% of 103 intended outcomes demonstrated a high impact, while 23% had limited or no measurable effect.1 Consequently, DHPCs often require repetition to reinforce key messages, i.e. despite prescribing restrictions introduced in 2019, fluoroquinolones continued to be used outside approved indications, prompting the issuance of an additional DHPC in June 2023.2 To date, limited research has examined stakeholder perspectives on barriers to implementing DHPCs and strategies needed to improve their effectiveness in clinical practice, highlighting a critical gap in the literature. Aim This study explored barriers and enablers to implementing DHPCs in Irish primary care to support more practical, context sensitive regulatory communication. Methods One-to-one semi-structured interviews were conducted using Microsoft Teams with GPs, community pharmacists, health policymakers, GP and pharmacist professional organisation representatives and national medicines regulators. Participants were recruited through the Irish College of General Practitioners and the Pharmaceutical Society of Ireland who facilitated the distribution of a survey to their respective members as part of a research study conducted by the research team. Respondents to that survey were invited to contact the lead author if interested in participating in an interview on the topic. The interview topic guide explored experience with DHPCs, views on current layout, enablers and barriers to DHPC implementation and perspectives on how to improve DHPC implementation. Data were analysed using inductive thematic analysis as outlined by Braun and Clarke. Results are reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results Twenty-one stakeholders were interviewed: eight GPs, six community pharmacists, three professional organisation representatives and two policymakers, two regulators. Three interrelated themes emerged. (1) Contrasting professional priorities in actioning DHPCs: pharmacists perceived DHPCs as urgent and safety-critical, whereas GPs often deprioritised them amid high workloads and competing clinical demands. (2) Pharmacists willing but constrained, overloaded GPs and overlooked DHPCs: pharmacists’ capacity to implement change was limited by lack of access to patient clinical information, maintenance of interprofessional boundaries, and unclear assignment of responsibility. GPs experienced information overload, limited time, and insufficient practical guidance on the implementation of DHPCs. (3) Making DHPCs work in real-world practice: participants recommended concise, action-oriented DHPCs, centralised online resources and practice-based electronic patient record supports including template letters to send patients and medication update checklists. Conclusion Effectiveness of DHPCs depends on how the message is received, prioritised and implemented within clinical practice. This study highlights a substantial implementation gap with misaligned perceptions of DHPC urgency as well as professional boundaries and constraints; however, findings may have limited transferability. A shift from static communication delivery to collaborative, system-integrated communication, co-designed with frontline healthcare professionals is essential to strengthen the real-world impact of DHPCs on patient safety.