Aged Care Trial Finds Systems-Level Support Improves Guideline Implementation

A multistate randomized controlled trial from Monash University examined how residential aged-care facilities can translate clinical guidelines into everyday practice, finding that implementation strategies extending beyond simple guideline distribution were important to improving adherence.

The EMBRACE trial, conducted by researchers from the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, involved four long-term-care provider organizations and 19 residential facilities across New South Wales, Queensland, Western Australia and Victoria. The facilities applied Australia’s Clinical Practice Guidelines for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Care.

Rather than relying solely on a written manual, the trial used a package of implementation resources. These included nine targeted fact sheets, a 10-item checklist for monitoring medication side effects, and a companion guide for people living with dementia and their families. The study compared knowledge brokers with pharmacist education and passive distribution of the guidance.

Knowledge brokers acted as intermediaries between research evidence and facility practice. A companion longitudinal, multi-method study published in BMJ Quality & Safety followed how these roles developed during the 12-month trial. According to the researchers, brokers began by learning about local conditions and building relationships with staff before developing, delivering and evaluating quality-improvement initiatives.

The findings indicated that knowledge brokers’ effectiveness was shaped by factors within the facilities themselves. Monash researchers identified leadership, organizational culture and dedicated implementation support as important influences on whether evidence-based changes could take hold. The results suggest that producing a high-quality guideline is only one part of improving care; the systems surrounding its use also matter.

Professor Simon Bell, director of the Centre for Medicine Use and Safety, said conventional guideline dissemination often fails to account for the complex and fast-paced environment of long-term care. Senior Research Fellow Dr. Amanda Cross said successful quality improvement requires an understanding of how aged-care services are structured and operate, in addition to strong research evidence.

The work has implications beyond psychotropic-medication management. Australia is changing its residential long-term-care sector through new care models and integrated workforce roles, including the introduction of on-site pharmacists. The researchers said their findings offer a framework for using such roles at a systems level to support evidence-based practice.

New guidelines developed under Australia’s National Health and Medical Research Council standards are incorporating integrated knowledge translation, with the acceptability and feasibility of recommendations considered from the outset. The EMBRACE findings were published in Implementation Science, while the companion study appeared in BMJ Quality & Safety.