Implementation of evidence based treatment into clinical practice for older people – A negative trial

Abstract

This project took the strong evidence that vitamin D supplements reduce falls in older people living in residential aged care facilities and applied implementation science principles to investigate whether the prevalence of vitamin D supplement use could be increased. A multifaceted implementation program was developed that included education and targeted all stakeholders, use of audits and feedback, and addressing stakeholder beliefs and attitudes. Its effectiveness was assessed using a stepped wedge design. In the first group of 17 facilities (1466 residents) the prevalence of vitamin D supplement use was stable at 58% over the six month intervention period. Comparison data from control group facilities confirmed that the intervention was not effective in increasing supplement use. Despite a carefully designed implementation program the goal of increasing use of an evidence based treatment was not achieved. It is likely that this occurred due to a complex interplay of factors that meant behaviour did not change in key players (general practitioners, facility managers and staff, and family caregivers and older people). This project has shown that an evidence based treatment recommendation and a best practice implementation program is not sufficient. In this case a direct action approach through general practitioners may have been more effective.