Adaptation of Evidence-Based Interventions

Bash, Heidi La; Thomas, Fiona C.; Stirman, Shannon Wiltsey

doi:10.1891/9780826186935.0004

Cited by 4 publications

(4 citation statements)

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“…Because of the low maintenance of the intervention observed in this study, we suggest that for future implementations, champions be better identified and engaged earlier in the implementation process [ 57 ], as one potential solution to better implement deprescribing interventions. Indeed, champions are defined as individuals (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism for how this implementation strategy works varies, for example it may be by them having a positive attitude towards it, by serving as team leader or by educating staff about the intervention [ 58 , 59 ]. Thus, champions are known to effectively facilitate implementation and maintenance of a new intervention [ 57 , 60 ]. Other solutions could also be considered, such as using the Normalization Process Theory [ 61 ] or tools such as NoMad [ 62 ].”…”

Section: Discussionmentioning

confidence: 99%

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Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study

Mena,

Moullin,

Schneider

et al. 2023

BMC Geriatr

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study

Mena,

Moullin,

Schneider

et al. 2023

BMC Geriatr

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“…Considering these barriers, facilitating factors, and the above insights in implementation science, adaptation of the intervention itself becomes essential to develop a low-resource programme suitable for communities. Bash et al proposed eight adaptation steps (Table 1 ) [ 26 ]. Step 1 involved assessing the needs (health and welfare, planning, and community health promotion) of the management staff and public health nurses in the target area of Obu City, identifying reasons and adaptation goals.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults: a research protocol

Kuroda,

Fujita,

Sugimoto

et al. 2023

Arch Public Health

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Background Multi-domain interventions effectively prevent dementia in clinical settings; however, their efficacy within local communities is unclear. This study assesses the feasibility of an adapted multi-domain intervention for dementia prevention in community-dwelling older adults. Methods The single-arm trial enrolls 60 participants from two Obu City communities, Japan. Primary outcome: participant retention in the adapted multi-domain intervention; secondary outcomes: health and implementation outcomes. Over 12 months, a team of researchers and public health nurse oversees the study in the first half, gradually shifting the management to public health nurses in the second half. Using the Framework for Reporting Adaptations and Modifications-Enhanced, the clinical programme is adjusted for the local community. It includes a 60-minute exercise and 30-minute group sessions, targeting lifestyle, diet, and social participation. Discussion This pioneer study evaluates the feasibility of an adapted intervention programme for dementia prevention in a community setting. Challenges in disseminating dementia prevention programmes warrant further investigation into effective implementation as well as strategies and methods to appeal to the target population. Upon confirming this programme’s feasibility, future studies can further evaluate its broader effectiveness. Trial registration The protocol is registered with the Clinical Trials Registry (UMIN-CTR) of the University Hospital’s Medical Information Network, under registration number UMIN000050581.

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“…A variety of methods can be used to identify adaptations and modifications to EBPs, including observation, therapist interviews, self-report, and medical record/clinical documentation review. Each has advantages and drawbacks in terms of resources required, reliability, and level of detail ( 1 , 11 ). Using clinical documentation from medical records can be advantageous because it can minimize the additional burden to clinicians beyond completion of required clinical notes and documentation.…”

Section: Introductionmentioning

confidence: 99%

Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system

Stirman

Bash

Nelson

et al. 2022

Front. Public Health

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BackgroundThe US Department of Veterans Affairs (VA) has over 15 years of experience in delivery of evidence-based psychotherapies (EBPs). This paper describes strategies for using clinical documentation and administrative data to understand adherence and modifications to EBPs for Posttraumatic Stress Disorder (PTSD).MethodsThis study focused on two EBPs for PTSD, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). The sample included VA therapists from across the US who provided CPT and PE and the patients they treated over a 1-year period. The data sources for this study were templated EBP chart notes and VA administrative data. We used a manual review of note content and administrative data rules to code therapy adherence and modifications in 7,297 EBP sessions for 1,257 patients seen by 182 therapists. Two trained coders rated each therapy note and resolved discrepancies through consensus. To contextualize and explain variation in adherence and modifications, we conducted brief 30–45-min semi-structured interviews with a purposive subsample of these therapists (n = 32).FindingsCombining manual chart review and administrative data allowed for identification of 11 types of modifications. Raters disagreed on adherence for 30% of notes. The disagreement stemmed from the presence of therapy modifications that were not clearly documented, necessitating the development of decision rules and strategies for modification coding. Both therapists and patients contributed to the variance in the extent to which different modifications occurred. Therapist interviews demonstrated therapist awareness of modifying the protocols in the ways identified through chart review.ConclusionHealthcare systems can use data collected as part of routine care to understand how and when EBPs are modified but need to develop scalable strategies to document adaptations and modifications to EBPs in routine care.

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Adaptation of Evidence-Based Interventions

Cited by 4 publications

References 0 publications

Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study

Implementation of interprofessional quality circles on deprescribing in Swiss nursing homes: an observational study

Feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults: a research protocol

Assessment of modifications to evidence-based psychotherapies using administrative and chart note data from the US department of veterans affairs health care system

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