PDF(Pubmed)
Abstract：
BACKGROUND: 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: 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.
CONCLUSIONS: 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.
BACKGROUND: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 - retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .
METHODS: 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.
CONCLUSIONS: 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.
BACKGROUND: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623001141639. Registered 6 November 2023 - retrospectively registered, https://www.anzctr.org.au/TrialSearch.aspx .
摘要：
背景：临床实践指南建议禁止在老年住宅护理机构（RACF）中常规使用精神药物。知识经纪人是促进知识转化为实践的个人或团体。该试验的目的是评估使用知识经纪人翻译澳大利亚新的《痴呆症患者和住院老人护理中适当使用精神药物的临床实践指南》的有效性和成本效益。
方法：居住老年人CarE的循证医学知识经纪人（EMBRACE）试验是一项螺旋平衡的随机对照试验。这项为期12个月的试验将在维多利亚州的四个澳大利亚老年护理提供者组织运营的多达19个RACF中进行，新南威尔士州,西澳大利亚州和昆士兰州。RACF将随机接受三个级别的实施策略(知识中介服务，药剂师主导的药物教育活动的质量使用以及指南和辅助材料的分发)在三种药物环境中(抗精神病药，苯二氮卓类药物和抗抑郁药）。实施策略将由嵌入式现场老年护理药剂师在每个参与的RACF的系统级别工作。所有RACF将同时接受所有实施策略，但适用于不同的药物环境。主要结果将是6个月的RACF水平与指南建议和使用抗精神病药的人的良好实践声明一致的复合二分法测量。苯二氮卓类药物和抗抑郁药对行为的改变。次要结果将包括与指南一致使用抗精神病药的居民比例，在RACF水平和使用精神药物的居民比例上测量的苯二氮卓类药物和抗抑郁药，住院治疗,falls,受伤摔倒,多药，生活质量,日常生活活动,在RACF级别测量的药物事件和行为事件。
结论：EMBRACE试验研究了一种新的指南实施策略，以提高RACF中精神药物的安全和有效使用。我们预计这些发现将为知识经纪人在成功和具有成本效益的指南实施中的潜在作用提供新的信息。
背景：澳大利亚新西兰临床试验注册（ANZCTR）：ACTRN12623001141639。2023年11月6日注册-追溯注册，https://www.anzctr.org.au/TrialSearch.aspx.
方法：居住老年人CarE的循证医学知识经纪人（EMBRACE）试验是一项螺旋平衡的随机对照试验。这项为期12个月的试验将在维多利亚州的四个澳大利亚老年护理提供者组织运营的多达19个RACF中进行，新南威尔士州,西澳大利亚州和昆士兰州。RACF将随机接受三个级别的实施策略(知识中介服务，药剂师主导的药物教育活动的质量使用以及指南和辅助材料的分发)在三种药物环境中(抗精神病药，苯二氮卓类药物和抗抑郁药）。实施策略将由嵌入式现场老年护理药剂师在每个参与的RACF的系统级别工作。所有RACF将同时接受所有实施策略，但适用于不同的药物环境。主要结果将是6个月的RACF水平与指南建议和使用抗精神病药的人的良好实践声明一致的复合二分法测量。苯二氮卓类药物和抗抑郁药对行为的改变。次要结果将包括与指南一致使用抗精神病药的居民比例，在RACF水平和使用精神药物的居民比例上测量的苯二氮卓类药物和抗抑郁药，住院治疗,falls,受伤摔倒,多药，生活质量,日常生活活动,在RACF级别测量的药物事件和行为事件。
结论：EMBRACE试验研究了一种新的指南实施策略，以提高RACF中精神药物的安全和有效使用。我们预计这些发现将为知识经纪人在成功和具有成本效益的指南实施中的潜在作用提供新的信息。
背景：澳大利亚新西兰临床试验注册（ANZCTR）：ACTRN12623001141639。2023年11月6日注册-追溯注册，https://www.anzctr.org.au/TrialSearch.aspx.
