Evaluating the implementation of a deprescribing intervention in Swiss nursing homes: An observational study using qualitative and quantitative methods

TL;DR

This study evaluated a deprescribing program in Swiss nursing homes, finding it was mostly successful but faced challenges like resistance and staff turnover.

Contribution

The study provides insights into factors influencing deprescribing implementation and offers strategies for long-term sustainability in nursing homes.

Findings

IDeI was successfully implemented in six of seven nursing homes with high healthcare professional satisfaction.

Interprofessional collaboration and pharmacist access to medical records were key facilitators of implementation.

Sustained implementation was only achieved in two nursing homes after one year.

Abstract

Deprescribing, the withdrawal of inappropriate medications, is an appropriate approach to addressing polypharmacy in older adults. However, implementing deprescribing interventions in routine practice remains challenging. This study evaluated the implementation of medication reviews focused on deprescribing, called Individual Deprescribing Intervention (IDeI), in Swiss nursing homes.

Using a hybrid type 2 effectiveness-implementation design, we conducted a qualitative evaluation through semi-structured interviews with nurses, physicians and pharmacists, based on the Framework for the Implementation of Pharmacy Services (FISpH). Quantitative data were collected from administrative sources.

IDeI was successfully implemented in six of seven nursing homes and most healthcare professionals (HCPs) were satisfied. Fidelity was considered good, as only minor intervention adaptations were made. Five main determinants influenced implementation: interprofessional collaboration (facilitator), pharmacist access to medical records (facilitator), motivation fostered by the structured process (facilitator), resident/family resistance to deprescribing (barrier), and resident/staff turnover (barrier). Integration into routine practice was deemed feasible but sustained in only two nursing homes one year later.

IDeI achieved good reach, adoption and HCP satisfaction, providing insights for sustainability. Recommendations include financial incentives, pharmacist training, audit & feedback and greater involvement of residents/families. Findings align with existing literature, emphasizing the need to reinforce interprofessional collaboration and long-term maintenance strategies.

•Intervention was successfully implemented in six of seven Swiss nursing homes.•Inter-collaboration, access to files, structured processes improved implementation.•Resident and family resistance and resident and staff turnover were barriers.•Maintenance one year later achieved only in two nursing homes.•Financial incentives, pharmacist training, audit and feedback support maintenance.

Intervention was successfully implemented in six of seven Swiss nursing homes.

Inter-collaboration, access to files, structured processes improved implementation.

Resident and family resistance and resident and staff turnover were barriers.

Maintenance one year later achieved only in two nursing homes.

Financial incentives, pharmacist training, audit and feedback support maintenance.