Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) : protocol for a helix-counterbalanced randomised controlled trial

Journal article


Bell, J. Simon, La Caze, Adam, Steeper, Michelle, Haines, Terry, Hilmer, S, Troeung, Lakkhina, Quirke, Lyntara, Wesson, Jacqueline, Pond, Constance Dimity, Buys, Elinor Laurie, Ghahreman-Falconer, Nazanin, Lawless, Michael T., Shrestha, Shakti, Martini, Angelita and Ochieng, Nancy. (2024). Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) : protocol for a helix-counterbalanced randomised controlled trial. Implementation Science. 19(1), pp. 1-15. https://doi.org/10.1186/s13012-024-01353-z
AuthorsBell, J. Simon, La Caze, Adam, Steeper, Michelle, Haines, Terry, Hilmer, S, Troeung, Lakkhina, Quirke, Lyntara, Wesson, Jacqueline, Pond, Constance Dimity, Buys, Elinor Laurie, Ghahreman-Falconer, Nazanin, Lawless, Michael T., Shrestha, Shakti, Martini, Angelita and Ochieng, Nancy
Abstract

Introduction: Clinical practice guidelines recommend against the routine use of psychotropic medications in residential aged care facilities (RACFs). Knowledge brokers are individuals or groups who facilitate the transfer of knowledge into practice. The objective of this trial is to evaluate the effectiveness and cost-effectiveness of using knowledge brokers to translate Australia’s new Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care.

Methods and analysis: The Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial is a helix-counterbalanced randomised controlled trial. The 12-month trial will be conducted in up to 19 RACFs operated by four Australian aged care provider organisations in Victoria, New South Wales, Western Australia and Queensland. RACFs will be randomised to receive three levels of implementation strategies (knowledge broker service, pharmacist-led quality use of medications education activities and distribution of the Guidelines and supporting materials) across three medication contexts (antipsychotics, benzodiazepines and antidepressants). Implementation strategies will be delivered by an embedded on-site aged care pharmacist working at a system level across each participating RACF. All RACFs will receive all implementation strategies simultaneously but for different medication contexts. The primary outcome will be a composite dichotomous measure of 6-month RACF-level concordance with Guideline recommendations and good practice statements among people using antipsychotics, benzodiazepines and antidepressants for changed behaviours. Secondary outcomes will include proportion of residents with Guideline concordant use of antipsychotics, benzodiazepines and antidepressants measured at the RACF-level and proportion of residents with psychotropic medication use, hospitalisation, falls, falls with injury, polypharmacy, quality of life, activities of daily living, medication incidents and behavioural incidents measured at the RACF-level.

Discussion: The EMBRACE trial investigates a novel guideline implementation strategy to improve the safe and effective use of psychotropic medications in RACFs. We anticipate that the findings will provide new information on the potential role of knowledge brokers for successful and cost-effective guideline implementation.

KeywordsLong‑term care; Residential facilities; Randomised controlled trial; Implementation science; Practice guidelines as topic; Implementation strategies; Inappropriate prescribing; Dementia; Evidence‑based practice; Psychotropic drugs
Year01 Jan 2024
JournalImplementation Science
Journal citation19 (1), pp. 1-15
PublisherSpringer Nature
ISSN1748-5908
Digital Object Identifier (DOI)https://doi.org/10.1186/s13012-024-01353-z
Web address (URL)https://implementationscience.biomedcentral.com/articles/10.1186/s13012-024-01353-z
Open accessOpen access
Research or scholarlyResearch
Page range1-15
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License
File Access Level
Open
Output statusPublished
Publication dates
Online04 Apr 2024
Publication process dates
Accepted13 Feb 2024
Deposited23 Oct 2024
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© The Author(s) 2024

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Place of publicationUnited Kingdom
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