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 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.

Download Full-text

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

Implementation Science ◽

10.1186/s13012-021-01116-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alyson Keen ◽

Kelli Thoele ◽

Ukamaka Oruche ◽

Robin Newhouse

Keyword(s):

Acute Care ◽

Brief Intervention ◽

Qualitative Data ◽

Implementation Strategies ◽

Implementation Process ◽

Clinical Intervention ◽

Structured Interview ◽

Positive Health ◽

Implementing Change

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.

Download Full-text

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.

Download Full-text

The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation

BMC Health Services Research ◽

10.1186/s12913-019-4668-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 8

Author(s):

Ulrica von Thiele Schwarz ◽

Gregory A. Aarons ◽

Henna Hasson

Keyword(s):

Patient Outcomes ◽

Theoretical Approach ◽

Internal Validity ◽

Implementation Strategies ◽

Implementation Process ◽

Evidence Based ◽

A Value ◽

The One ◽

Practice Implementation ◽

Fidelity And Adaptation

Abstract Background There has long been debate about the balance between fidelity to evidence-based interventions (EBIs) and the need for adaptation for specific contexts or particular patients. The debate is relevant to virtually all clinical areas. This paper synthesises arguments from both fidelity and adaptation perspectives to provide a comprehensive understanding of the challenges involved, and proposes a theoretical and practical approach for how fidelity and adaptation can optimally be managed. Discussion There are convincing arguments in support of both fidelity and adaptations, representing the perspectives of intervention developers and internal validity on the one hand and users and external validity on the other. Instead of characterizing fidelity and adaptation as mutually exclusive, we propose that they may better be conceptualized as complimentary, representing two synergistic perspectives that can increase the relevance of research, and provide a practical way to approach the goal of optimizing patient outcomes. The theoretical approach proposed, the “Value Equation,” provides a method for reconciling the fidelity and adaptation debate by putting it in relation to the value (V) that is produced. The equation involves three terms: intervention (IN), context (C), and implementation strategies (IS). Fidelity and adaptation determine how these terms are balanced and, in turn, the end product – the value it produces for patients, providers, organizations, and systems. The Value Equation summarizes three central propositions: 1) The end product of implementation efforts should emphasize overall value rather than only the intervention effects, 2) implementation strategies can be construed as a method to create fit between EBIs and context, and 3) transparency is vital; not only for the intervention but for all of the four terms of the equation. Summary There are merits to arguments for both fidelity and adaptation. We propose a theoretical approach, a Value Equation, to reconciling the fidelity and adaptation debate. Although there are complexities in the equation and the propositions, we suggest that the Value Equation be used in developing and testing hypotheses that can help implementation science move toward a more granular understanding of the roles of fidelity and adaptation in the implementation process, and ultimately sustainability of practices that provide value to stakeholders.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Lessons Learned During Large-Scale Implementation Project Focused on Workplace Lactation Practices and Policies

American Journal of Health Promotion ◽

10.1177/08901171211055692 ◽

2021 ◽

pp. 089011712110556

Author(s):

Amanda Hickey ◽

Margaret Henning ◽

Lissa Sirois

Keyword(s):

Large Scale ◽

Implementation Process ◽

Lessons Learned ◽

Self Report ◽

Evidence Based ◽

Work Site ◽

Practice Based Research ◽

Post Test ◽

Control And Prevention

Purpose This practice-based research funded by the Centers for Disease Control and Prevention (CDC) focuses on the translation of evidence-based practices and policies into real-world applications. To the best of our knowledge, this is the largest study to research the implementation process for lactation accommodations and policies for work sites. Design or Approach Pre-/post-test evaluation of work-site lactation accommodations, and 6-month follow-up with business that worked on the project. Setting/Participants 34 businesses across New Hampshire. Method The team developed work-site selection criteria to award mini-grants; developed trainings and a toolkit; and worked with 34 businesses over a 3-year period. Pre-/post-implementation data were collected using the CDC work-site scorecard. A 6-month follow-up phone interview was conducted with each site. Results We assessed the CDC scorecard and evaluated the challenges of implementing lactation spaces by industry. In our 6-month follow-up, we found that spaces were still being utilized and we identified specific research to inform practical evidence-based applications and lessons learned when implementing a work-site lactation space. Conclusion We successfully provided financial/technical support to develop or improve 45 lactation spaces, with policies and practices to support mothers and families for 34 businesses. We identified key takeaway lessons that can be used to guide the development of lactation spaces and policies in work sites. Sites self-report that these work-site changes were sustainable at 6-month follow-up.

Download Full-text

Development and use of a toolkit to facilitate implementation of an evidence-based intervention: a descriptive case study

Implementation Science Communications ◽

10.1186/s43058-020-00081-x ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Kelli Thoele ◽

Melora Ferren ◽

Laura Moffat ◽

Alyson Keen ◽

Robin Newhouse

Keyword(s):

Implementation Strategies ◽

Clinical Intervention ◽

Evidence Based ◽

Descriptive Case Study ◽

Implementation Effectiveness ◽

Clinical Nurses ◽

Effective Strategies ◽

Policies And Procedures ◽

External Stakeholders

Abstract Background Implementation of evidence-based clinical interventions in real-world settings becomes a futile effort when effective strategies to foster adoption are not used. A toolkit, or a collection of adaptable documents to inform and facilitate implementation, can increase the use of evidence-based interventions. Most available toolkits provide resources about the intervention but lack guidance for adaptation to different contexts or strategies to support implementation. This paper describes the development and use of a toolkit to guide the implementation of an evidence-based intervention to identify and intervene for people with risky substance use. Methods A descriptive case study describes the development and use of a toolkit throughout a two-year study. Investigators and site coordinators from 14 acute care hospitals developed tools and engaged external stakeholders as they prepared for implementation, integrated the clinical intervention into practice, and reflected on implementation. Results The final toolkit included 54 different tools selected or created to define the intervention, engage and communicate with stakeholders, assess for readiness and plan for implementation, train clinical nurses and other stakeholders, evaluate training and implementation effectiveness, create policies and procedures for different contexts, and identify opportunities for reimbursement. Each tool corresponds to one or more implementation strategies. Conclusion The approach used to develop this implementation toolkit may be used to create resources for the implementation of other evidence-based interventions.

Download Full-text

Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: results of a before/after survey study

BMJ Open ◽

10.1136/bmjopen-2018-028740 ◽

2019 ◽

Vol 9 (10) ◽

pp. e028740 ◽

Cited By ~ 1

Author(s):

Andrea Niederhauser ◽

Stephanie Züllig ◽

Jonas Marschall ◽

Alexander Schweiger ◽

Gregor John ◽

...

Keyword(s):

Acute Care ◽

Response Rate ◽

Urinary Catheter ◽

Acute Care Hospitals ◽

Evidence Based ◽

Improvement Project ◽

Staff Members ◽

Indwelling Urinary Catheter ◽

Current Practices

ObjectiveTo evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project.DesignRepeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017).SettingSeven acute care hospitals in Switzerland.ParticipantsThe survey was targeted at all nursing and medical staff members working at the participating hospitals at the time of survey distribution. A total of 1579 staff members participated in the baseline survey (T0) (49% response rate) and 1527 participated in the follow-up survey (T1) (47% response rate).InterventionA multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter need and staff training, was implemented over the course of 9 months.Main outcome measuresStaff knowledge (15 items), perception of current practices and culture (scale 1–7), self-reported responsibilities (multiple-response question) and determinants of behaviour (scale 1–7) before and after implementation of the intervention bundle.ResultsThe mean number of correctly answered knowledge questions increased significantly between the two survey periods (T0: 10.4, T1: 11.0; p<0.001). Self-reported responsibilities with regard to IUC management by nurses and physicians changed only slightly over time. Perception of current practices and culture in regard to safe urinary catheter use increased significantly (T0: 5.3, T1: 5.5; p<0.001). Significant changes were also observed for determinants of behaviour (T0: 5.3, T1: 5.6; p<0.001).ConclusionWe found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. Efforts now need to be targeted at sustaining and reinforcing these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.

Download Full-text