Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study

Janet K. Sluggett, Georgina A. Hughes, Choon Ean Ooi, Esa Y. H. Chen, Megan Corlis, Michelle E. Hogan, Tessa Caporale, Jan Van Emden and J. Simon Bell
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Janet K. Sluggett: UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia
Georgina A. Hughes: UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
Choon Ean Ooi: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
Esa Y. H. Chen: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
Megan Corlis: UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia
Michelle E. Hogan: Helping Hand Aged Care, North Adelaide, SA 5006, Australia
Tessa Caporale: Helping Hand Aged Care, North Adelaide, SA 5006, Australia
Jan Van Emden: NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia
J. Simon Bell: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia

IJERPH, 2021, vol. 18, issue 11, 1-17

Abstract: Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs.

Keywords: process assessment; health care; aged; nursing homes; long-term care; residential facilities; medication therapy management; medication administration; medication systems; qualitative research; randomized controlled trial; Australia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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