BACKGROUND The COME-ON study was a cluster-controlled trial of a complex intervention that consisted of a blended training program, local interdisciplinary meetings, and interdisciplinary case conferences in Belgian nursing homes. The intervention was associated with significant improvements in the appropriateness of prescribing. The aims of this study were to describe the implementation of the intervention and to explore the experiences of participants, for the purpose of identifying factors associated with implementation and perceived impact and to draw lessons for future implementation. METHODS We performed a mixed-method process evaluation. Questionnaires and reports were used to collect quantitative data on implementation and experiences from the 24 NHs and participating healthcare professionals (coordinating physicians, general practitioners, pharmacists, and nurses) in the intervention group. Multidisciplinary focus groups focusing on factors associated with implementation and perceived impact were conducted in 11 NHs. RESULTS Overall, the rate of implementation and the satisfaction of participants were good, despite some variability between NHs and HCPs. Although perceived impact on nursing home residents varied, most participants perceived a positive impact for themselves. Factors associated with implementation and perceived impact were identified at different levels: intervention, healthcare professionals, organization, and external context. The interdisciplinary and face-to-face approaches were recognized as key elements for the success of the intervention, despite organizational constraints. The attitude of general practitioners was identified both as a barrier to and a facilitator for implementation and its success. The professional role and competency of the pharmacist influenced perceived impact. The pre-existing relationships between HCPs and the presence of a leader facilitated implementation and perceived impact. Remuneration was deemed necessary for the study and for future implementation. CONCLUSIONS Overall, the intervention, and more specifically its interdisciplinary aspect, was well implemented and appreciated by HCPs. This probably contributed to the positive effect on the appropriateness of prescribing. Future implementation must take into account the various factors found to affect implementation and perceived impact, in order to maximize effect and sustainability. Trial registration Current Controlled Trials ISRCTN66138978; registered 18 November 2015, retrospectively registered, https://www.isrctn.com/ISRCTN66138978.

中文翻译：

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为优化疗养院处方质量而进行的复杂干预措施的过程评估（COME-ON研究）。

背景技术COME-ON研究是一项复杂干预的群集控制试验，该复杂干预包括混合培训计划，本地跨学科会议和比利时疗养院跨学科案例会议。干预措施与处方适当性的显着改善有关。这项研究的目的是描述干预措施的实施，并探索参与者的经验，以识别与实施和感知影响相关的因素，并为未来的实施汲取教训。方法我们进行了混合方法过程评估。调查问卷和报告用于收集来自24个国家医疗机构和参与的医疗保健专业人员（协调医生，干预组中的全科医生，药剂师和护士）。在11个国家/地区中，开展了多学科焦点小组，重点关注与实施和感知影响相关的因素。结果总体而言，尽管NHs和HCP之间存在一定差异，但实施率和参与者满意度都很高。尽管对养老院居民的感知影响各不相同，但大多数参与者对自己产生了积极影响。在不同级别确定了与实施和感知影响相关的因素：干预，医疗保健专业人员，组织和外部环境。尽管存在组织上的限制，但跨学科和面对面的方法仍被认为是干预成功的关键要素。全科医生的态度被认为是实施及其成功的障碍和促进者。药剂师的专业角色和能力影响了感知的影响。HCP之间先前存在的关系以及领导者的存在促进了实施和可察觉的影响。薪酬被认为是研究和未来实施所必需的。结论总的来说，干预措施，尤其是其跨学科方面，得到了HCP的良好实施和赞赏。这可能有助于对开处方的适当性产生积极影响。未来的实施必须考虑到影响实施和感知影响的各种因素，以最大程度地发挥效果和可持续性。试用注册电流对照试验ISRCTN66138978；已于2015年11月18日注册，并追溯注册，https：//www.isrctn.com/ISRCTN66138978。