To report our experiences with the tailoring process including intervention fidelity, which we examined by means of a process evaluation going along with the trial.
After the paradigm shift towards an evidence-based treatment of patients, the number of guidelines has been increasing. However, guidelines are often not followed by care providers. This “evidence-practice-gap” is a major barrier to establishing sustainable healthcare. Implementation research examines how to implement the current “best practice” into routine care with lasting effect. One approach is the development of “tailored” interventions (TI), which comprise strategies selected to address specific, previously identified barriers. We performed a Cluster-RCT to evaluate a TI to implement three guideline recommendations for multimorbid patients with polypharmacy into German General Practices, which are: Medication counseling, use of medication lists and avoidance of potentially inappropriate medication.
A TI and the associated 'logic model”, stating the previously identified determinants and strategies, was developed. 22 General Practitioners (GPs) and 344 patients were included in a randomized trial. The TI consisted of a workshop, individual improvement concepts for practices and resources for GPs and patients. The primary outcome of the trial was “degree of implementation', measured by a set of indicators. The experiences of GPs and practice nurses with the study were assed by interviews and a written survey.
The methods used for tailoring seem appropriate to identify relevant determinants and potentially effective strategies. However, attitudes and awareness should be considered as possible barriers to sustainable implementation and intervention fidelity. The combination of qualitative and quantitative methods resulted in a better understanding of the ongoing processes.
How can we “tailor” interventions on a more individual level taking into account particular circumstances in individual practices to improve health care in a sustainable manner?