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



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.



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.



Australian New Zealand Clinial Trials Registry ACTRN12615000401550.
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia. lindy.clemson@sydney.edu.au.|Centre of Excellence in Population Ageing Research, Sydney, Australia. lindy.clemson@sydney.edu.au.
Lindy
0000-0003-2687-1114
L
Clemson
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Lynette
L
Mackenzie
Sydney Medical School - Northern, The University of Sydney, Sydney, Australia.
Chris
C
Roberts
School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.
Roslyn
R
Poulos
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Amy
A
Tan
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Meryl
M
Lovarini
The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
Cathie
C
Sherrington
Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Judy M
JM
Simpson
Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia.
Karen
K
Willis
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Mary
M
Lam
The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
Anne
A
Tiedemann
School of Medicine & Public Health, University of Newcastle, Newcastle, Australia.
Dimity
D
Pond
The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
David
D
Peiris
Sydney Medical School - Northern, The University of Sydney, Sydney, Australia.|Kolling Institute of Medical Research, The University of Sydney, Sydney, Australia.
Sarah
S
Hilmer
University Centre for Rural Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
Sabrina Winona
SW
Pit
Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Kirsten
K
Howard
Clinical Excellence Commission, Sydney, Australia.
Lorraine
L
Lovitt
Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Fiona
F
White
D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control*; D000368:Aged; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D058006:General Practice / Q000191:economics / Q000379:methods*; D006801:Humans; D007400:Interprofessional Relations; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D012944:Social Support; D016896:Treatment Outcome