Factors Affecting Implementation of the EQUIPPED Medication Safety Program for Older Veterans in the Emergency Department: A Qualitative Analysis.

BACKGROUND: EQUIPPED (Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department) is a program developed within the Veterans Affairs (VA) health system that aims to reduce the prescription of potentially inappropriate medications (PIMs) for people aged 65 and over. A recent trial evaluated implementation of EQUIPPED via (1) academic detailing, which involves one-on-one provider guidance and coaching, or (2) dashboards that monitor providers' PIM prescribing rates. Evidence suggests better implementation among academic detailing sites, but qualitative evidence is lacking. OBJECTIVE: Our objective is to identify individual and organizational factors that affect EQUIPPED implementation and to compare these factors across the program's two audit and feedback arms. METHODS: Four academic detailing sites and three dashboard sites (comprising a total of 28 interviewees) were included in this qualitative analysis between May 2019 and June 2022; each site submitted regular site adaptation reports and participated in a series of interviews (1) at baseline, (2) after 6-8 months of implementation, and (3) a year after the first interview. Thematic analysis was done using constructs from the Organizational Theory of Implementation Effectiveness; reports from participating sites were also compared and analyzed using a categorization matrix. RESULTS: Respondents from both arms underlined the importance of change valence, innovation-values fit, and situational factors, such as ongoing accreditation, in fostering a favorable implementation climate for EQUIPPED. A unique challenge for academic detailing sites was the lack of resources and time to implement the mentoring intervention; dashboard sites encountered difficulties in sustaining momentum and motivation among providers. Common challenges included the prompt development and approval of medication order sets. CONCLUSION AND RECOMMENDATIONS: Results suggest the importance of implementation climate, alignment with shared individual and organizational values, and seamless integration of EQUIPPED implementation within existing workflows. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04004936.

Duke Scholars

Author Jaifred (Jim) Lopez  

Author Heather Alyse King Population Health Sciences

Author George Lee Jackson Population Health Sciences

Author Susan Nicole Hastings Medicine, General Internal Medicine