Applying Implementation Science Methods to Prospectively Track the Adaptation of an Evidence-Based Deprescribing...

Area of Science:

• Gerontology
• Pharmacology
• Implementation Science

Background:

• Falls are a significant risk for older adults, with central nervous system-active medications increasing this risk.
• The Centers for Disease Control and Prevention funded the STOP-FALLS pragmatic trial to evaluate a deprescribing intervention aimed at reducing falls.
• Implementation process data were collected alongside the trial to understand how the intervention was adopted.

Purpose of the Study:

• To describe prospective modifications made to the STOP-FALLS intervention.
• To summarize the implementation strategies used in a real-world healthcare setting.
• To adhere to reporting recommendations from implementation science.

Main Methods:

• A preimplementation phase involved collaboration with delivery system leaders to adapt the intervention.
• Focus groups with end-users were conducted to optimize patient educational materials.
• The intervention was pilot-tested in a primary care setting within the Kaiser Permanente Washington system.

Main Results:

• Twenty-seven adaptations were made to the STOP-FALLS intervention.
• Thirteen distinct implementation strategies were deployed across three preimplementation phases.

Conclusions:

• Intervention adaptations addressed trial guidelines (e.g., including opioid medications) and specific healthcare system operations.
• Refinements were made to enhance the intervention based on patient and primary care practitioner feedback.
• The deployed implementation strategies may serve as best practices for future pragmatic trials embedded in health systems.