title: Developmental evaluation as a strategy to enhance the uptake and use of deprescribing guidelines: protocol for a multiple case study.
abstract: BACKGROUND
  The use of developmental evaluation is increasing as a method for conducting implementation research. This paper describes the use of developmental evaluation to enhance an ongoing study. The study develops and implements evidence-based clinical guidelines for deprescribing medications in primary care and long-term care settings. A unique feature of our approach is our use of a rapid analytical technique.
  
  
  METHODS
  The team will carry out two separate analytical processes: first, a rapid analytical process to provide timely feedback to the guideline development and implementation teams, followed by a meta-evaluation and second, a comprehensive qualitative analysis of data after the implementation of each guideline and a final cross-case analysis. Data will be gathered through interviews, through observational techniques leading to the creation of field notes and narrative reports, and through assembling team documents such as meeting minutes. Transcripts and documents will be anonymized and organized in NVIVO by case, by sector (primary care or long-term care), and by implementation site. A narrative case report, directed coding, and open coding steps will be followed. Clustering and theming will generate a model or action map reflecting the functioning of the participating social environments.
  
  
  CONCLUSIONS
  In this study, we will develop three deprescribing guidelines and will implement them in six sites (three family health teams and three long-term care homes), in a sequential iterative manner encompassing 18 implementation efforts. The processes of 11 distinct teams within four conceptual categories will be examined: a guideline priority-setting group, a guideline development methods committee, 3 guideline development teams, and 6 guideline implementation teams. Our methods will reveal the processes used to develop and implement the guidelines, the role and contribution of developmental evaluation in strengthening these processes, and the experience of six sites in implementing new evidence-based clinical guidelines. This research will generate new knowledge about team processes and the uptake and use of deprescribing guidelines in family health teams and long-term care homes, with a goal of addressing polypharmacy in Canada. Clinicians and researchers creating clinical guidelines to introduce improvements into daily practice may benefit from our developmental evaluation approach.
authors.affiliation: Department of Applied Human Sciences, Concordia University, Montreal, Quebec, Canada. james.conklin@concordia.ca.|Bruyère Research Institute, Ottawa, Canada. james.conklin@concordia.ca.
authors.forename: James
authors.initials: J
authors.lastname: Conklin
authors.affiliation: Bruyère Research Institute, Ottawa, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Canada.|School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
authors.affiliation: Bruyère Research Institute, Ottawa, Canada.|School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Ward
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.|Women's College Research Institute, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: McCarthy
authors.affiliation: Bruyère Research Institute, Ottawa, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Irving
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lalitha
authors.initials: L
authors.lastname: Raman-Wilms
mesh_terms: D002170:Canada; D000069340:Deprescriptions; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000592:standards; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D012107:Research Design