Evaluating the implementation of a deprescribing intervention in Swiss nursing homes: An observational study using qualitative and quantitative methods

Deprescribing, the withdrawal of inappropriate medications, is an appropriate approach to addressing polypharmacy in older adults. However, implementing deprescribing interventions in routine practice remains challenging. This study evaluated the implementation of medication reviews focused on deprescribing, called Individual Deprescribing Intervention (IDeI), in Swiss nursing homes. Using a hybrid type 2 effectiveness-implementation design, we conducted a qualitative evaluation through semi-structured interviews with nurses, physicians and pharmacists, based on the Framework for the Implementation of Pharmacy Services (FISpH). Quantitative data were collected from administrative sources. IDeI was successfully implemented in six of seven nursing homes and most healthcare professionals (HCPs) were satisfied. Fidelity was considered good, as only minor intervention adaptations were made. Five main determinants influenced implementation: interprofessional collaboration (facilitator), pharmacist access to medical records (facilitator), motivation fostered by the structured process (facilitator), resident/family resistance to deprescribing (barrier), and resident/staff turnover (barrier). Integration into routine practice was deemed feasible but sustained in only two nursing homes one year later. IDeI achieved good reach, adoption and HCP satisfaction, providing insights for sustainability. Recommendations include financial incentives, pharmacist training, audit & feedback and greater involvement of residents/families. Findings align with existing literature, emphasizing the need to reinforce interprofessional collaboration and long-term maintenance strategies.