TY - JOUR
KW - Alcohol use disorder pharmacotherapy
KW - implementation
KW - implementation barriers
KW - Primary Care Mental Health Integration
AU - H. J. Hagedorn
AU - J. P. Wisdom
AU - H. Gerould
AU - E. Pinsker
AU - R. Brown
AU - M. Dawes
AU - E. Dieperink
AU - D. H. Myrick
AU - E. M. Oliva
AU - T. H. Wagner
AU - A. H. S. Harris
A1 - 
AB - BACKGROUND: Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. METHODS: Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5-10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. RESULTS: Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers' limited knowledge and negative beliefs about AUD pharmacotherapy and providers' negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. CONCLUSIONS: CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes.
AD - Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA. hildi.hagedorn@va.gov.; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA. hildi.hagedorn@va.gov.; Jennifer Wisdom Consulting, New York, New York, NY, 10010, USA.; Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.; Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.; William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.; Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA.; Substance Abuse Treatment Program, South Texas Veterans Affairs Health Care System, San Antonio, TX, 78229, USA.; Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA.; Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.; Center for Drug and Alcohol Problems, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, 29401, USA.; Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC, 29425, USA.; Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA.; Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA(TRUNCATED)
BT - Addiction science & clinical practice
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 1
CY - England
DO - 10.1186/s13722-019-0151-7
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Despite the high prevalence of alcohol use disorders (AUDs), in 2016, only 7.8% of individuals meeting diagnostic criteria received any type of AUD treatment. Developing options for treatment within primary care settings is imperative to increase treatment access. As part of a trial to implement AUD pharmacotherapy in primary care settings, this qualitative study analyzed pre-implementation provider interviews using the Consolidated Framework for Implementation Research (CFIR) to identify implementation barriers. METHODS: Three large Veterans Health Administration facilities participated in the implementation intervention. Local providers were trained to serve as implementation/clinical champions and received external facilitation from the project team. Primary care providers received a dashboard of patients with AUD for case identification, educational materials, and access to consultation from clinical champions. Veterans with AUD diagnoses received educational information in the mail. Prior to the start of implementation activities, 24 primary care providers (5-10 per site) participated in semi-structured interviews. Transcripts were analyzed using common coding techniques for qualitative data using the CFIR codebook Innovation/Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals domains. Number and type of barriers identified were compared to quantitative changes in AUD pharmacotherapy prescribing rates. RESULTS: Four major barriers emerged across all three sites: complexity of providing AUD pharmacotherapy in primary care, the limited compatibility of AUD treatment with existing primary care processes, providers' limited knowledge and negative beliefs about AUD pharmacotherapy and providers' negative attitudes toward patients with AUD. Site specific barriers included lack of relative advantage of providing AUD pharmacotherapy in primary care over current practice, complaints about the design quality and packaging of implementation intervention materials, limited priority of addressing AUD in primary care and limited available resources to implement AUD pharmacotherapy in primary care. CONCLUSIONS: CFIR constructs were useful for identifying pre-implementation barriers that informed refinements to the implementation intervention. The number and type of pre-implementation barriers identified did not demonstrate a clear relationship to the degree to which sites were able to improve AUD pharmacotherapy prescribing rate. Site-level implementation process factors such as leadership support and provider turn-over likely also interacted with pre-implementation barriers to drive implementation outcomes.
PP - England
PY - 2019
SN - 1940-0640; 1940-0632
SP - 24
T1 - Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes
T2 - Addiction science & clinical practice
TI - Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 31291996
U3 - 10.1186/s13722-019-0151-7
VL - 14
VO - 1940-0640; 1940-0632
Y1 - 2019
Y2 - Jul 10
ER -