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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Study protocol

Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design

Authors: Lindy Clemson, Lynette Mackenzie, Chris Roberts, Roslyn Poulos, Amy Tan, Meryl Lovarini, Cathie Sherrington, Judy M. Simpson, Karen Willis, Mary Lam, Anne Tiedemann, Dimity Pond, David Peiris, Sarah Hilmer, Sabrina Winona Pit, Kirsten Howard, Lorraine Lovitt, Fiona White

Published in: Implementation Science | Issue 1/2017

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Abstract

Background

Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention.

Methods/design

This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates.

Discussion

The design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery.

Trial registration

Australian New Zealand Clinial Trials Registry ACTRN12615000401​550
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Metadata
Title
Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design
Authors
Lindy Clemson
Lynette Mackenzie
Chris Roberts
Roslyn Poulos
Amy Tan
Meryl Lovarini
Cathie Sherrington
Judy M. Simpson
Karen Willis
Mary Lam
Anne Tiedemann
Dimity Pond
David Peiris
Sarah Hilmer
Sabrina Winona Pit
Kirsten Howard
Lorraine Lovitt
Fiona White
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-016-0529-9

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