TY - JOUR
T1 - Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE)
T2 - protocol for a helix-counterbalanced randomised controlled trial
AU - Bell, J. Simon
AU - La Caze, Adam
AU - Steeper, Michelle
AU - Haines, Terry P.
AU - Hilmer, Sarah N.
AU - Troeung, Lakkhina
AU - Quirke, Lyntara
AU - Wesson, Jacqueline
AU - Pond, Constance Dimity
AU - Buys, Laurie
AU - Ghahreman-Falconer, Nazanin
AU - Lawless, Michael T.
AU - Shrestha, Shakti
AU - Martini, Angelita
AU - Ochieng, Nancy
AU - Glamorgan, Francesca
AU - Lagasca, Carmela
AU - Walton, Rebecca
AU - Cenin, Dayna
AU - Kitson, Alison
AU - Jung, Monica
AU - Bennett, Alexandra
AU - Cross, Amanda J.
N1 - Funding Information:
J. S. B. has received grant funding or consulting funds from the National Health and Medical Research Council, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organisations unrelated to this work. All grants and consulting funds were paid to the employing institution. J. W. was previously employed at Montefiore Homes and continues to have a professional links with them, including paid mentoring roles. A. J. C. has received grant funding or consulting funds from the Medical Research Future Fund and Pharmaceutical Society of Australia. All grants and consulting funds were paid to the employing institution. The other authors declare that they have no competing interests.
Funding Information:
This work was supported by the Australian Government Medical Research Future Fund (GA187306). AJC is supported by an NHMRC Emerging Leadership 1 grant (APP2009633).
Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - 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. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx.
AB - 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. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 — retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx.
KW - Dementia
KW - Evidence-based practice
KW - Implementation science
KW - Implementation strategies
KW - Inappropriate prescribing
KW - Long-term care
KW - Practice guidelines as topic
KW - Psychotropic drugs
KW - Randomised controlled trial
KW - Residential facilities
UR - http://www.scopus.com/inward/record.url?scp=85186845461&partnerID=8YFLogxK
U2 - 10.1186/s13012-024-01353-z
DO - 10.1186/s13012-024-01353-z
M3 - Article
C2 - 38438918
AN - SCOPUS:85186845461
SN - 1748-5908
VL - 19
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 24
ER -
