Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: A type 2 hybrid effectiveness-implementation design

Clemson, L; Mackenzie, L; Roberts, C; Poulos, R; Tan, A; Lovarini, M; Sherrington, C; Simpson, JM; Willis, K; Lam, M; Tiedemann, A; Pond, D; Peiris, D; Hilmer, S; Pit, SW; Howard, K; Lovitt, L; White, F

Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: A type 2 hybrid effectiveness-implementation design

Clemson, L

Mackenzie, L Roberts, C Poulos, R Tan, A Lovarini, M Sherrington, C Simpson, JM Willis, K Lam, M

Tiedemann, A Pond, D Peiris, D Hilmer, S Pit, SW Howard, K Lovitt, L White, F

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Publication Type:: Journal Article
Citation:: Implementation Science, 2017, 12 (1)
Issue Date:: 2017-02-07

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Field	Value	Language
dc.contributor.author	Clemson, L https://orcid.org/0000-0003-2687-1114	en_US
dc.contributor.author	Mackenzie, L	en_US
dc.contributor.author	Roberts, C	en_US
dc.contributor.author	Poulos, R	en_US
dc.contributor.author	Tan, A	en_US
dc.contributor.author	Lovarini, M	en_US
dc.contributor.author	Sherrington, C	en_US
dc.contributor.author	Simpson, JM	en_US
dc.contributor.author	Willis, K	en_US
dc.contributor.author	Lam, M https://orcid.org/0000-0001-9451-8203	en_US
dc.contributor.author	Tiedemann, A	en_US
dc.contributor.author	Pond, D	en_US
dc.contributor.author	Peiris, D	en_US
dc.contributor.author	Hilmer, S	en_US
dc.contributor.author	Pit, SW	en_US
dc.contributor.author	Howard, K	en_US
dc.contributor.author	Lovitt, L	en_US
dc.contributor.author	White, F	en_US
dc.date.available	2016-12-01	en_US
dc.date.issued	2017-02-07	en_US
dc.identifier.citation	Implementation Science, 2017, 12 (1)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124651
dc.description.abstract	© 2016 The Author(s). Background: Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention. Methods/design: This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates. Discussion: The design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery. Trial registration: Australian New Zealand Clinial Trials Registry ACTRN12615000401550	en_US
dc.relation.ispartof	Implementation Science	en_US
dc.relation.isbasedon	10.1186/s13012-016-0529-9	en_US
dc.subject.classification	Health Policy & Services	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Cluster Analysis	en_US
dc.subject.mesh	Interprofessional Relations	en_US
dc.subject.mesh	Accidental Falls	en_US
dc.subject.mesh	Social Support	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	General Practice	en_US
dc.subject.mesh	Practice Patterns, Physicians'	en_US
dc.title	Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: A type 2 hybrid effectiveness-implementation design	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	12	en_US
utslib.for	111001 Aged Care Nursing	en_US
utslib.for	08 Information and Computing Sciences	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	12	en_US

Abstract:

© 2016 The Author(s). Background: Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention. Methods/design: This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates. Discussion: The design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery. Trial registration: Australian New Zealand Clinial Trials Registry ACTRN12615000401550

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http://hdl.handle.net/10453/124651