Factors Affecting Implementation of the EQUIPPED Medication Safety Program for Older Veterans in the Emergency...

EQUIPPED (Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department) is a program developed within the Veterans Affairs (VA) health system that aims to reduce the prescription of potentially inappropriate medications (PIMs) for people aged 65 and over. A recent trial evaluated implementation of EQUIPPED via (1) academic detailing, which involves one-on-one provider guidance and coaching, or (2) dashboards that monitor providers' PIM prescribing rates. Evidence suggests better implementation among academic detailing sites, but qualitative evidence is lacking.

Our objective is to identify individual and organizational factors that affect EQUIPPED implementation and to compare these factors across the program's two audit and feedback arms.

Four academic detailing sites and three dashboard sites (comprising a total of 28 interviewees) were included in this qualitative analysis between May 2019 and June 2022; each site submitted regular site adaptation reports and participated in a series of interviews (1) at baseline, (2) after 6-8 months of implementation, and (3) a year after the first interview. Thematic analysis was done using constructs from the Organizational Theory of Implementation Effectiveness; reports from participating sites were also compared and analyzed using a categorization matrix.

Respondents from both arms underlined the importance of change valence, innovation-values fit, and situational factors, such as ongoing accreditation, in fostering a favorable implementation climate for EQUIPPED. A unique challenge for academic detailing sites was the lack of resources and time to implement the mentoring intervention; dashboard sites encountered difficulties in sustaining momentum and motivation among providers. Common challenges included the prompt development and approval of medication order sets.

Results suggest the importance of implementation climate, alignment with shared individual and organizational values, and seamless integration of EQUIPPED implementation within existing workflows.

ClinicalTrials.gov identifier: NCT04004936.