Programme no. 528-OP
Quality Improvement
Improving healthcare for multimorbid patients receiving polypharmacy – experiences with the development and delivery of a tailored intervention
Cornelia Jäger1, Tobias Freund2, Sarah Kuse3, Joachim Szecsenyi4, Jost Steinhäuser*5
1General Practice and Health Services Research,University Hospital Heidelberg,Heidelberg,Germany, 2General Practice and Health Services Research,University Hospital Heidelberg,Heidelberg,Germany, 3General Practice and Health Services Research,University Hospital Heidelberg,Heidelberg,Germany, 4General Practice and Health Services Research,University Hospital Heidelberg,Heidelberg,Germany, 5Institute of General Practice,University Hospital Schleswig-Holstein,Lübeck,Germany
* = Presenting author
Objectives:

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.

Background:

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.

Results: First descriptive analyses of the survey indicate that the logic model has largely been confirmed. Most of the identified determinants were perceived as relevant and most of the strategies selected to address these determinants were perceived as helpful by the target group. The interviews, however, revealed aspects partly contradictory to the results of the survey, e.g. concerning the use of checklists. Rejection towards standardization of health care and lacking awareness for performance gaps were identified as relevant factors for intervention fidelity.
Material/Methods:

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.

Conclusion:

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.

Points for discussion: How is the attitude towards standardisation of health care in other countries?

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?