Perceptions of the barriers, facilitators, outcomes, and helpfulness of strategies to implement screening, brief intervention, and referral to treatment in acute care

Abstract Background Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a clinical intervention used to address alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. Qualitative data were analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful implementation strategies were reexamining the implementation (M = 4.38; n = 8), providing ongoing consultation (M = 4.13; n = 8), auditing and providing feedback (M = 4.1; n = 10), developing education materials (M = 4.1; n = 10), identifying and preparing champions (M = 4; n = 7), and tailoring strategies (M = 4; n = 7). Conclusion SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

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Perceptions of the Barriers, Facilitators, Outcomes, and Helpfulness of Strategies to Implement Screening, Brief Intervention, and Referral to Treatment in Acute Care

10.21203/rs.3.rs-61664/v2 ◽

2021 ◽

Author(s):

Alyson Keen ◽

Kelli M Thoele ◽

Ukamaka Oruche ◽

Robin Newhouse

Keyword(s):

Acute Care ◽

Brief Intervention ◽

Qualitative Data ◽

Implementation Strategies ◽

Implementation Process ◽

Clinical Intervention ◽

Structured Interview ◽

Evidence Based ◽

Positive Health

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based clinical intervention used to reduce alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes; however, SBIRT implementation remains low. Research on implementing evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework to guide comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to qualitative feedback gathered from site coordinators (SCs) leading SBIRT implementation. The purpose of this study was to describe the SCs’ experiences pertaining to SBIRT implementation across a health system. Methods: Within the context of a larger parent study, a semi-structured interview guide was used to capture 14 SCs’ perceptions of the barriers, facilitators, and outcomes pertaining to SBIRT implementation. This qualitative data was analyzed using standard content analytic procedures. A follow-up survey was developed based on 14 ERIC strategies identified from qualitative data and was administered electronically to determine the SC’s perceptions of the most helpful implementation strategies on a scale of 1 (least helpful) to 5 (most helpful). Results: All 14 invited SCs participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most helpful ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: SCs who led implementation efforts within a large healthcare system identified several barriers and facilitators to the implementation of SBIRT. Additionally, they identified clinician-related outcomes associated with SBIRT implementation into practice as well as strategies that were helpful in the implementation process. This information can inform the implementation of SBIRT and other interventions in acute care settings.

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Descriptive Evaluation of SBIRT Adoption, Implementation, and Delivery across a Health System

10.21203/rs.3.rs-61664/v1 ◽

2020 ◽

Author(s):

Alyson Keen ◽

Kelli M Thoele ◽

Ukamaka Oruche ◽

Robin Newhouse

Keyword(s):

Health System ◽

Implementation Strategies ◽

Structured Interview ◽

Evidence Based ◽

Positive Health ◽

Sustaining Change ◽

Implementing Change ◽

Implementation Studies ◽

Common Framework

Abstract Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based intervention used to enhance reductions in alcohol and illicit drug use. SBIRT use has resulted in positive health and social outcomes. However, SBIRT implementation remains low. Research on implementation of evidence-based interventions, such as SBIRT, lacks information about challenges and successes related to implementation. The Expert Recommendations for Implementing Change (ERIC) provides a framework that improves the comprehension, clarity, and relevance of strategies available for implementation research. This framework was applied to structure findings from analyses of qualitative interview data gathered from local champions leading SBIRT implementation. The purpose of this study was to understand site coordinators’ (SCs) perceptions of SBIRT implementation and employed strategies. Study aims included (1) describe SCs’ perceptions of barriers, facilitators, and outcomes related to SBIRT implementation, and (2) describe strategies perceived as most effective to implement SBIRT. Methods: This was a descriptive study conducted with 14 SCs, representing 14 medical surgical units within a large healthcare system. A semi-structured interview guide was developed by the study team to capture barriers, facilitators, and outcomes related to SBIRT implementation. A follow-up survey, based on 14 commonly identified ERIC strategies during SC interviews, was administered to determine the SC’s perceptions of the most helpful (i.e. effective) implementation strategies on a scale of 1 (least helpful) to 5 (most helpful).Results: All site coordinators participated in the SBIRT implementation interview, and 11 of 14 (79%) responded to the follow-up survey. Within the categories of barriers, facilitators, and outcomes, 25 subthemes emerged. The most highly rated effective ERIC implementation strategies were purposely reexamining the implementation (M=4.38; n=8), providing ongoing consultation (M=4.13; n=8), auditing and providing feedback (M=4.1; n=10), developing education materials (M=4.1; n=10), identifying and preparing champions (M=4; n=7), and tailoring strategies (M=4; n=7). Conclusion: This study applied a common framework (ERIC) to implementation lessons within a large health system that can be replicated in other implementation studies and quality improvement efforts. Adapting and sustaining change are challenging in healthcare settings. However, understanding and using the most helpful implementations strategies may support healthcare teams to adopt and sustain interventions such as SBIRT.

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Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network

Journal of Personalized Medicine ◽

10.3390/jpm11070647 ◽

2021 ◽

Vol 11 (7) ◽

pp. 647

Author(s):

Nina R. Sperber ◽

Olivia M. Dong ◽

Megan C. Roberts ◽

Paul Dexter ◽

Amanda R. Elsey ◽

...

Keyword(s):

Precision Medicine ◽

Program Implementation ◽

Clinical Care ◽

Genomic Medicine ◽

Implementation Strategies ◽

Clinical Decision ◽

Implementing Change ◽

Implementation Outcomes ◽

Planning Framework

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

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P092: Exercise prescription in the emergency department: patient perceptions

CJEM ◽

10.1017/cem.2017.294 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S109

Author(s):

F. Milne ◽

K. Leech-Porter ◽

D. Lewis ◽

J. Fraser ◽

S. Hull ◽

...

Keyword(s):

Emergency Department ◽

Pilot Study ◽

Exercise Prescription ◽

Tertiary Care ◽

Intervention Group ◽

Emergency Department Patient ◽

Likert Scale ◽

Structured Interview ◽

Positive Health

Introduction: The positive health outcomes of exercise have been well-studied, and exercise prescription has been shown to reduce morbidity in several chronic health conditions. However, patient attitudes around the prescription of exercise in the emergency department (ED) have not been explored. The aim of our pilot study is to explore patients’ willingness and perceptions of exercise being discussed and prescribed in the ED. Methods: This study is a survey of patients who had been previously selected for exercise prescription in a pilot study conducted at a tertiary care ED. This intervention group were given a standardized provincial written prescription to perform moderate exercise for 150 minutes per week. Participants answered a discharge questionnaire and were followed up by a telephone interview 2 months later. A structured interview of opinions around exercise prescription was conducted. Questions included a combination of non-closed style interview questions and Likert scale. Patients rated prescription detail, helpfulness and likelihood on a Likert scale from 1-5 (1 being strongly disagree and 5 being strongly agree). Median values (+/-IQRs) are presented, along with dominant themes. Results: 17 people consented to exercise prescription and follow up surveys. 2 were excluded due to hospital admission. 15 participants were enrolled and completed the discharge survey. Two-month follow up survey response rate was 80%. Patients rated the detail given in their prescription as 5 (+/-1). Helpfulness of prescription was rated as 4 (+/-2). Likelihood to continue exercising based on the prescription was rated as 4 (+/-2). 11/12 participants felt that exercise should be discussed in the Emergency Department either routinely or on a case-by-case basis.1 participant felt it should not be discussed at all. Conclusion: Our study demonstrates that most patients are open to exercise being discussed during their Emergency Department visit, and that the prescription format was well-received by study participants.

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Dear (Digital) Diary

10.4018/978-1-7998-8473-6.ch023 ◽

2022 ◽

pp. 375-389

Author(s):

Veronica Moretti

Keyword(s):

Social Network ◽

Qualitative Data ◽

Phase 1 ◽

Structured Interview ◽

Phase 2 ◽

Daily Lives ◽

Advantages And Disadvantages ◽

Technological Tools ◽

The Subject

This chapter investigates how individuals interpreted and considered the audio-diary technique, understanding the interaction between the subject and the medium and the potential of new technological tools (e.g., smartphone, social network) in producing data. The research is based on a previous study conducted during the COVID-19 lockdown in Italy, more specifically, the transition from phase 1 to phase 2. Each participant—11 female and 6 male, between 28 and 45 years old, and living in the northern part of Italy—was asked to register one audio per day for a week (7-13 May). After this period, the author undertook a final follow-up semi-structured interview to evaluate how much the audio-diary had an impact both on people's daily lives and on their way of expressing information. The data collected suggest a number of advantages and disadvantages to the use of audio-diary to collect individuals' experience. The author will briefly describe the steps of AD technique by using the collected material (interviews) and what has emerged from the analysis of qualitative data.

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A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation

The Gerontologist ◽

10.1093/geront/gnz011 ◽

2019 ◽

Vol 60 (4) ◽

pp. 776-786 ◽

Cited By ~ 1

Author(s):

Cassandra Leighton ◽

Beth Fields ◽

Juleen L Rodakowski ◽

Connie Feiler ◽

Mary Hawk ◽

...

Keyword(s):

Organizational Context ◽

Care Delivery ◽

Implementation Strategies ◽

Implementation Process ◽

Structured Interview ◽

Routine Care ◽

System Level ◽

Financing System ◽

Implementation Team

Abstract Background and Objectives The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act’s three components into routine care delivery. Research Design and Methods We conducted a multisite, ethnographic case study at three different hospitals’ medical–surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. Results Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. Discussion and Implications General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.

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Strategies to promote the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) in healthcare settings: a scoping review

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00380-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Kelli Thoele ◽

Laura Moffat ◽

Stephanie Konicek ◽

Monika Lam-Chi ◽

Erica Newkirk ◽

...

Keyword(s):

Primary Care ◽

Brief Intervention ◽

Scoping Review ◽

Implementation Strategies ◽

Implementation Process ◽

The United States ◽

Healthcare Settings ◽

Primary Care Settings ◽

Implementation Outcomes ◽

Prevention And Treatment

Abstract Background Screening, brief intervention, and referral to treatment (SBIRT), is an approach for the prevention and treatment of substance use disorders, but is often underutilized in healthcare settings. Although the implementation of SBIRT is challenging, the use of multi-faceted and higher intensity strategies are more likely to result in the successful incorporation of SBIRT into practice in primary care settings. SBIRT may be used in different healthcare settings, and the context for implementation and types of strategies used to support implementation may vary by setting. The purpose of this scoping review is to provide an overview regarding the use of strategies to support implementation of SBIRT in all healthcare settings and describe the associated outcomes. Methods A scoping review was conducted using CINAHL Complete, HealthBusiness FullTEXT, PsycINFO, PubMed, and Embase to search for articles published in English prior to September 2019. The search returned 462 citations, with 18 articles included in the review. Two independent reviewers extracted data from each article regarding the theory, design, timeline, location, setting, patient population, substance type, provider, sample size and type, implementation strategies, and implementation outcomes. The reviewers entered all extracted data entered into a table and then summarized the results. Results Most of the studies were conducted in the United States in primary care or emergency department settings, and the majority of studies focused on SBIRT to address alcohol use in adults. The most commonly used strategies to support implementation included training and educating stakeholders or developing stakeholder interrelationships. In contrast, only a few studies engaged patients or consumers in the implementation process. Efforts to support implementation often resulted in an increase in screening, but the evidence regarding the brief intervention is less clear, and most studies did not assess the reach or adoption of the referral to treatment. Discussion In addition to summarizing the strategies used to increase reach and adoption of SBIRT in healthcare settings, this scoping review identified multiple gaps in the literature. Two major gaps include implementation of SBIRT in acute care settings and the application of implementation theories to inform healthcare efforts to enable use of SBIRT.

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Tailoring implementation for a cancer self-management support intervention for patients starting chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.287 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 287-287 ◽

Cited By ~ 1

Author(s):

Ryan Lawrence Kirkby ◽

Doris Howell ◽

Melanie Lynn Powis ◽

Heidi Amernic ◽

Lesley Moody ◽

...

Keyword(s):

Communication Networks ◽

Qualitative Data ◽

Implementation Strategies ◽

Self Management ◽

Management Support ◽

Implementation Barriers ◽

Implementing Change ◽

Tailored Implementation ◽

Administrative Leaders ◽

The Impact

287 Background: Multiple implementation strategies are described in the literature; however, there is limited consensus on how to best tailor implementation to organizational and clinician readiness. We undertook a mixed-methods evaluation to inform tailored implementation of self-management support (SMS) in ambulatory cancer care as the first phase of a pilot randomized trial of the intervention in patients starting chemotherapy. Methods: Validated surveys, focus groups and interviews were undertaken with key stakeholders (oncologists, nurses, allied health, and administrative leaders) in the lung, colorectal and lymphoma disease site groups at 3 regional cancer centres in Ontario, Canada. Median responses to individual survey questions were classified as an enabler, barrier or neutral based on predetermined cut-offs. Enablers and barriers were triangulated with qualitative data and mapped to the Consolidated Framework for Implementation Research domains. Implementation strategies to address barriers were identified using the Expert Recommendations for Implementing Change tool. Results: Survey respondents represented all stakeholder groups (n = 78; respondent rate = 50%). Minimal variation was noted across stakeholders and centres. Overall, respondents held positive beliefs about the value of SMS, were familiar with the principles of SMS and felt there was a tangible fit among the intervention, individual beliefs, and existing workflows. Suboptimal communication networks and access to information about the adoption of SMS, as well as a lack of organizational commitment to implementing the intervention were identified as key implementation barriers. Qualitative data reinforced quantitative findings, namely that stakeholders value SMS but were unsure if it would translate into reduced treatment toxicities. 46 implementation strategies were identified based on perceived barriers, of which 28 (61%) were common to all 3 centres. Conclusions: Stakeholders at cancer centres acknowledged that SMS is valuable, but potential barriers to integration of SMS into routine ambulatory practice exist. The impact of the tailored implementation plans will be evaluated as part of the trial.

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Factors Affecting the Use and Consequences of Management Accounting Practices in A Transitional Economy: The Case of Vietnam

Journal of Economics and Development ◽

10.33301/2016.18.01.04 ◽

2016 ◽

pp. 54-73 ◽

Cited By ~ 2

Author(s):

Anh Doan Ngoc Phi

Keyword(s):

Significant Influence ◽

Quantitative Data ◽

Structural Equation ◽

Qualitative Data ◽

Management Accounting ◽

Transitional Economy ◽

Equation Modeling ◽

Enterprise Performance ◽

Factors Affecting

This study seeks to help fill an important gap in the literature by investigating factors that have facilitated the use of management accounting practices (MAPs) in Vietnam - a transitional economy. Data were collected from 220 medium-to-large enterprises. Follow-up interviews were conducted with 20 accounting heads/vice heads to obtain further information and clarification. The quantitative data collected was analyzed using both descriptive and inferential statistics (including t-tests and structural equation modeling), while the qualitative data was used to shed further light on the various relationships described by the quantitative analysis. This paper reveals that both decentralization and competition have a positive, significant influence on the use of new MAPs except for the old ones. Consequently, the use of MAPs has a positive, significant influence on enterprise performance.

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School Leaders’ Practice of the Ethics of Educational Leadership to Make Decisions

Journal of Education in Black Sea Region ◽

10.31578/jebs.v4i1.151 ◽

2018 ◽

Vol 4 (1) ◽

pp. 10-34

Author(s):

Mohammed Assiri

Keyword(s):

Educational Leadership ◽

Mixed Methods Research ◽

Qualitative Data ◽

School Leaders ◽

Leadership Skills ◽

Common Factors ◽

Teaching Experience ◽

Structured Interview ◽

School Year ◽

Ethical Decisions

Abstract This study aimed to investigate the extent to which school leaders practice the ethics of educational leadership to make decisions. A mixed-methods research design was used in this study. The quantitative data of this study were obtained from the participation of 260 teachers, and the qualitative data of this study were collected from nine school leaders. The questionnaire and the semi-structured interview were used to collect the data. The study was conducted during the school year of 2017-2018. The study found that the overall extent to which school leaders practice the ethics of educational leadership to make decisions was classified as “always occurs". The findings showed that there were statistically significant differences between participants with different gender and school levels on the overall and all dimensions of the extent to which school leaders practice the ethics of educational leadership to make decisions, while there were not statistically significant differences between the groups of the participants with different teaching experience. The qualitative findings provided some common factors that influence school leaders’ practice to making ethical decisions. These factors were explained based on two concepts including management knowledge and leadership skills as well as the context of school's culture.

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