Deimplementing Untested Practicesin Homecare Services: A Preobservational-Postobservational Design

Withcommunity-dwellingelderswaitingtoadapttheirbathroom,HealthandSocialServicesCentersinQuebec (Canada)combinedhumanresourcesthroughcross-skillingwithininterdisciplinaryteams.Tothisend,occupationaltherapists implementedin-house“tools”tosupportnonoccupationaltherapistsinselectingbathingequipment.However,unknown psychometricpropertiesofthosein-house“tools”castdoubtonthequalityofserviceprovidedtoelders.Littleisalsoknown aboutthebestprocessestousetosupportthedeimplementationofsuchnonevidence-basedpractices.Thisstudypresentsthe effectofaknowledgetransferandexchangeinterventiondesignedtodeimplementin-house“tools”andreplacethemwithan evidence-basedtool(Algo).Methods.Censuseswereconductedwiththe94HealthandSocialServicesCentersofQuebec providinghomecareservices,beforeandaftertheknowledgetransferandexchangeintervention(2009-2013).In2013,the deimplementationofin-house“tools”andtheirreplacementbyAlgoweremeasuredwithKnottandWildavsky’slevelsof utilization.Results.Cross-skillingwithininterdisciplinaryteamsincreasedbetweencensuses(87%to98%),asdiduseof in-house“tools”(67%to81%).Algo’suptakestartedduringtheknowledgetransferandexchangeprocessas25Healthand SocialServicesCentersachievedthefirstlevelofutilization.Nonetheless,noHealthandSocialServicesCenterdeimplemented thein-house“tools”touseAlgo.Conclusion.Theknowledgetransferandexchangeprocessledtothedevelopmentofa scientificallysoundclinicaltool(Algo)andchallengedthestatusquoinclinicalsettingsregardingtheuseofnonevidence-based practices.However,thedeimplementationofin-usepracticeshasnotyetbeenobserved.Thisstudyhighlightstheneedtoact proactivelyonthedeimplementationandimplementationprocesses.