IDeI (Individual Deprescribing Intervention) implémentation

By withdrawing inappropriate medications, deprescribing is recognized as a safe way to address polypharmacy in older adults. However, the implementation of deprescribing interventions into routine clinical practice remains challenging. 

In this study, we evaluate the implementation of a specific type of medication review intervention focused on deprescribing, called Individual Deprescribing Intervention (IDeI), in six Swiss nursing homes. The study was integrated in an effectiveness-implementation hybrid type 2 design. The implementation evaluation component uses both qualitative and quantitative methods through semi-structured interviews of healthcare professionals (HCPs) to explore six implementation outcomes. The topic guides were based on the Framework for the Implementation of Services in Pharmacy (FISpH), tailored to nurses, physicians, pharmacists. 

Our results showed that the IDeI was successfully implemented during a pragmatic randomized controlled trial. Most HCPs were satisfied with the intervention and felt that it could be integrated into their routine practice. Using an implementation science approach offers new insights on the implementation of intervention to address polypharmacy in nursing homes. 

Indeed, the evaluation was useful to recommend to stakeholders that future implementation efforts include remuneration for HCPs, specific training and continuous audit and feedback as implementation strategies. In addition, this study shows the benefit of deprescribing interventions being evaluated in terms of impact, combining monitoring of clinical and implementation outcomes.