AI Article Synopsis
- Polypharmacy and the use of potentially inappropriate medications (PIMs) are common issues among older adults in nursing homes, and the QC-DeMo intervention aims to address this by helping healthcare professionals create a consensus on which PIMs to reduce.
- The study evaluated the implementation of the QC-DeMo intervention across 26 nursing homes, utilizing questionnaires to measure its effectiveness in terms of reach, adoption, and fidelity, while also identifying strategies for better integration into existing practices.
- While the intervention showed successful initial implementation, it struggled with long-term maintenance as none of the nursing homes continued the practice after the trial, despite positive feedback from healthcare professionals about the training and strategies used.
Article Abstract
Background: Polypharmacy and potentially inappropriate medications (PIMs) are still frequent among older adults in nursing homes. Deprescribing is an intervention that has been shown to be effective in reducing their use. However, the implementation of deprescribing in clinical practice has not yet been widely evaluated. The Quality Circle Deprescribing Module (QC-DeMo) intervention has been trialled through an effectiveness-implementation hybrid type 2 design. The intervention consists of a quality circle workshop session between healthcare professionals HCPs (physicians, nurses, and pharmacists) within a nursing home, in which they define a consensus to deprescribe specific PIMs classes. The aim of this study was to evaluate the implementation of the QC-DeMo intervention in nursing homes.
Methods: This observational study focuses on the implementation part of the QC-DeMo trial. Implementation was based on the Framework for Implementation of Pharmacy Services (FISpH). Questionnaires at baseline and follow-up were used to evaluate reach, adoption, implementation effectiveness, fidelity, implementation, maintenance and the implementation strategies. Other data were collected from the QC-DeMo trial and routine data collected as part of the integrated pharmacy service where the QC-Demo trial was embedded. Implementation strategies included training of pharmacists, integration of the intervention into an existing quality circle dynamic and definition of tailored strategies to operationalise the consensus by each nursing home.
Results: The QC-DeMo intervention was successfully implemented in 26 nursing homes in terms of reach, fidelity, adoption, implementation and implementation effectiveness. However, the intervention was found to be implemented with low maintenance as none of the nursing homes repeated the intervention after the trial. Implementation strategies were well received by HCPs: training was adequate according to pharmacists. Pre-existing quality circle dynamic facilitated interprofessional collaboration as involvement and support of each HCP was rated as high. HCPs recognized a specific and important role for each HCP in the deprescribing process. The most relevant tailored strategies to implement the consensus defined by each nursing home were identification of the patients by the pharmacist and a systematic review of medication's patients.
Conclusions: The implementation of a Quality Circle on Deprescribing is feasible but its maintenance in practice remains challenging. This study explores multiple implementation outcomes to better inform future implementation efforts of these types of interventions.
Trial Registration: ClinicalTrials.gov ( NCT03688542 ), registered on 26.09.2018.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548671 | PMC |
| http://dx.doi.org/10.1186/s12877-023-04335-w | DOI Listing |
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