Developing, implementing and evaluating a complex intervention to optimize medication prescribing in the nursing home setting

Concerns have often been raised regarding the appropriateness of prescribing in the nursing home setting, leading to an urgent need to implement and evaluate approaches for optimization. In this context, a national multicenter cluster controlled trial was launched to evaluate the effect of a complex intervention. The COME-ON intervention included a blended training program, local concertations and interdisciplinary case conferences. At baseline, the prevalence of potentially inappropriate prescribing (PIP) was high and some residents and nursing homes characteristics were associated with PIP. The intervention was effective in improving the appropriateness of prescribing. An in-depth process evaluation, using mixed methods, provided data on the implementation and experience of participating healthcare professionals. This work has provided valuable information for researchers, healthcare professionals and policy makers – including on the barriers and facilitators to be taken into account for implementation on a wider scale, as well as for future research on the development and assessment of new healthcare interventions to optimize pharmacotherapy in nursing home residents.