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Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design
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 be...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296956/ https://www.ncbi.nlm.nih.gov/pubmed/28173827 http://dx.doi.org/10.1186/s13012-016-0529-9 |
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author | Clemson, Lindy Mackenzie, Lynette Roberts, Chris Poulos, Roslyn Tan, Amy Lovarini, Meryl Sherrington, Cathie Simpson, Judy M. Willis, Karen Lam, Mary Tiedemann, Anne Pond, Dimity Peiris, David Hilmer, Sarah Pit, Sabrina Winona Howard, Kirsten Lovitt, Lorraine White, Fiona |
author_facet | Clemson, Lindy Mackenzie, Lynette Roberts, Chris Poulos, Roslyn Tan, Amy Lovarini, Meryl Sherrington, Cathie Simpson, Judy M. Willis, Karen Lam, Mary Tiedemann, Anne Pond, Dimity Peiris, David Hilmer, Sarah Pit, Sabrina Winona Howard, Kirsten Lovitt, Lorraine White, Fiona |
author_sort | Clemson, Lindy |
collection | PubMed |
description | 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 |
format | Online Article Text |
id | pubmed-5296956 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52969562017-02-10 Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design Clemson, Lindy Mackenzie, Lynette Roberts, Chris Poulos, Roslyn Tan, Amy Lovarini, Meryl Sherrington, Cathie Simpson, Judy M. Willis, Karen Lam, Mary Tiedemann, Anne Pond, Dimity Peiris, David Hilmer, Sarah Pit, Sabrina Winona Howard, Kirsten Lovitt, Lorraine White, Fiona Implement Sci Study Protocol 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 BioMed Central 2017-02-07 /pmc/articles/PMC5296956/ /pubmed/28173827 http://dx.doi.org/10.1186/s13012-016-0529-9 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Study Protocol Clemson, Lindy Mackenzie, Lynette Roberts, Chris Poulos, Roslyn Tan, Amy Lovarini, Meryl Sherrington, Cathie Simpson, Judy M. Willis, Karen Lam, Mary Tiedemann, Anne Pond, Dimity Peiris, David Hilmer, Sarah Pit, Sabrina Winona Howard, Kirsten Lovitt, Lorraine White, Fiona Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title | Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title_full | Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title_fullStr | Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title_full_unstemmed | Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title_short | Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design |
title_sort | integrated solutions for sustainable fall prevention in primary care, the isolve project: a type 2 hybrid effectiveness-implementation design |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296956/ https://www.ncbi.nlm.nih.gov/pubmed/28173827 http://dx.doi.org/10.1186/s13012-016-0529-9 |
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