Sustaining practice change in health care: the impact of a national quality improvement program on the uptake of collaborative medicines reviews

Ellett, Lisa M. Kalisch; Pratt, Nicole; Sluggett, Janet K.; Ramsay, Emmae; Kerr, Mhairi; LeBlanc, Vanessa T; Barratt, John D.; Gilbert, Andrew L.; Roughead, Elizabeth E.

doi:10.1002/jppr.1379

Cited by 9 publications

(11 citation statements)

References 31 publications

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“…Although the duration of use of risperidone decreased in the aged care population following the TGA labelling changes, from a median of 338 days per person prior to the changes to 240 days after, this was still in excess of the new 12-week (84 days) duration recommended by the TGA. Sustaining practice change in healthcare is difficult, and repetition of messages has been shown to improve the duration of healthcare improvements following healthcare interventions [34]. Future health improvement interventions will support a sustained reduction in the rate of use of risperidone for BPSD.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines

et al. 2019

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Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s dementia for a maximum twelve-week duration. We aimed to determine whether the rate and duration of risperidone use for BPSD decreased following the regulatory changes. Methods: we conducted a study using the Australian Government Department of Veterans’ Affairs administrative claims data and Pharmaceutical Benefits Scheme (PBS) 10% sample data. We included people aged 65 years or older and compared the rate and duration of risperidone use before and after the TGA labelling changes. Results: There was a sustained decrease in the trend of risperidone use for BPSD following the TGA labelling changes, with a monthly decrease of 1.7% in the aged care population, 0.5% in the community living population and 1.5% in the general older Australian population. Overall, in the 24 months post the TGA changes the reduction in the rate of use of risperidone ranged from 20% to 28% lower than compared to what the rate would have been without the TGA changes. The median duration of use of risperidone in aged-care residents decreased from 338 days in the year prior to the TGA labelling changes, to 240 days per person in the year after the changes. Conclusion: The TGA labelling changes were associated with a significant reduction in the rate of use of risperidone for BPSD in veterans living in both the aged care and community settings, and in the general older Australian population. The labelling changes were also associated with a reduced duration of risperidone use in aged care residents, although for most people the duration of use still exceeded the recommended 12-week maximum duration.

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Section: Discussionmentioning

confidence: 99%

Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines

et al. 2019

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“…However, participants in all three studies were predominately community dwelling (6%-20% RACF residents) and were not followed after discharge. Furthermore, evidence suggests that regular interventions reinforcing key messages are most effective for supporting sustained behavior change [38]. Future directions may include evaluation of the reproducibility of intervention effects when the intervention is provided over successive periods as it is possible that repeated simplification may further reduce administration times and other aspects of complexity.…”

Section: Resultsmentioning

confidence: 99%

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Sluggett

Hopkins

Chen

et al. 2020

JCM

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In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.

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“…Others have suggested that regular repetition of QI messages are needed to sustain improvements in practice. 35 …”

Section: Discussionmentioning

confidence: 99%

Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

et al. 2021

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BackgroundQuality improvement (QI) involves the use of systematic tools and methods to improve the quality of care and outcomes for patients. However, awareness and application of QI among healthcare professionals is poor and new strategies are needed to engage them in this area.ObjectivesThis study describes an innovative collaboration between one Higher Educational Institute (HEI) and Local Pharmaceutical Committees (LPCs) to develop a postgraduate QI module aimed to upskill community pharmacists in QI methods. The study explores pharmacist engagement with the learning and investigates the impact on their practice.MethodsDetails of the HEI–LPCs collaboration and communication with pharmacist were recorded. Focus groups were held with community pharmacists who enrolled onto the module to explore their motivation for undertaking the learning, how their knowledge of QI had changed and how they applied this learning in practice. A constructivist qualitative methodology was used to analyse the data.ResultsThe study found that a HEI–LPC partnership was feasible in developing and delivering the QI module. Fifteen pharmacists enrolled and following its completion, eight took part in one of two focus groups. Pharmacists reported a desire to extend and acquire new skills. The HEI–LPC partnership signalled a vote of confidence that gave pharmacists reassurance to sign up for the training. Some found returning to academia challenging and reported a lack of time and organisational support. Despite this, pharmacists demonstrated an enhanced understanding of QI, were more analytical in their day-to-day problem-solving and viewed the learning as having a positive impact on their team’s organisational culture with potential to improve service quality for patients.ConclusionsWith the increased adoption of new pharmacist’s roles and recent changes to governance associated with the COVID-19 pandemic, a HEI–LPC collaborative approach could upskill pharmacists and help them acquire skills to accommodate new working practices.

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Sustaining practice change in health care: the impact of a national quality improvement program on the uptake of collaborative medicines reviews

Abstract: Aim:We evaluated the impact of quality improvement interventions at different time points on the uptake of collaborative

Cited by 9 publications

References 31 publications

Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines

Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines

Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial

Engaging community pharmacists in quality improvement (QI): a qualitative case study of a partnership between a Higher Education Institute and Local Pharmaceutical Committees

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