Research Abstract: Free Paper - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

‘Demystifying’ POPS: Factors relevant to implementation of the perioperative medicine for older people undergoing surgery (POPS) service (#102)

Margot Lodge 1 2 3 , Jugdeep Dhesi 4 5 , David JH Shipway 6 7 , Philip Braude 6 , Catherine Meilak 8 , Judith Partridge 4 5 , Nadine E Andrew 1 2 , Velandai Srikanth 1 2 9 , Darshini R Ayton 1 10 11 , Chris Moran 1 2 3 9 11
  1. National Centre for Healthy Ageing, Melbourne, Victoria, Australia
  2. Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
  3. Health of Older People, Alfred Health, Melbourne, Victoria, Australia
  4. Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  5. King's College London, London, United Kingdom
  6. CLARITY (Collaborative Ageing Research) group, North Bristol NHS Trust, Bristol, United Kingdom
  7. University of Bristol, Bristol, United Kingdom
  8. East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
  9. Peninsula Health, Frankston, Victoria, Australia
  10. Health and Social Care Unit, Monash University, Melbourne, Victoria, Australia
  11. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Aim: The scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised in the United Kingdom (UK) or internationally. Implementation science provides a structured approach to understanding barriers and enablers to the implementation of models of care like POPS. This study aimed to use implementation science to identify factors relevant to the implementation of POPS services in the UK.

Methods: We undertook a qualitative case study at three National Health Service (NHS) Trusts. The trusts differed across contextual factors (population, workforce, size) and implementation maturity of their POPS services. We conducted semi-structured interviews with purposively sampled clinicians and managers (n=56). Data were thematically analysed and coded using the Consolidated Framework for Implementation Research (CFIR).

Results: Fourteen factors across all five domains of the CFIR were relevant to the implementation of POPS services, including those relating to the characteristics of the POPS intervention, the Trusts’ outer and inner settings, individuals involved in implementation and the process of implementation. Stakeholder understanding of the rationale and benefits of POPS services and health service networks to support the implementation of POPS services were identified as key factors relevant to implementation. Our results demonstrate variation and flexibility in the way that Trusts responded to these factors that were associated with the implementation of POPS services.

Conclusion: All five CFIR domains were addressed in a tailored manner based on local needs and capabilities for implementation of POPS services in three contextually different health care settings.