Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems.

Diane K King, Steven J Ondersma, Bonnie G McRee, Jacqueline S German, Amy M Loree, Amy Harlowe, Daniel P Alford, Robyn N M Sedotto, Mary Kate Weber
{"title":"Using Planned and Unplanned Adaptation to Implement Universal Alcohol Screening and Brief Intervention to Prevent Alcohol-Exposed Pregnancies in Four Primary Care Health Systems.","authors":"Diane K King, Steven J Ondersma, Bonnie G McRee, Jacqueline S German, Amy M Loree, Amy Harlowe, Daniel P Alford, Robyn N M Sedotto, Mary Kate Weber","doi":"10.1177/29767342241271404","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies.</p><p><strong>Methods: </strong>We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers.</p><p><strong>Results: </strong>Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving.</p><p><strong>Conclusions: </strong>Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.</p>","PeriodicalId":516535,"journal":{"name":"Substance use & addiction journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Substance use & addiction journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/29767342241271404","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies.

Methods: We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers.

Results: Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving.

Conclusions: Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.

利用计划内和计划外的调整,在四个初级医疗保健系统中实施普遍酒精筛查和简短干预,以预防暴露于酒精的妊娠。
背景:美国预防服务工作组建议每年对普通成年人和孕妇进行酒精筛查和简短行为干预(酒精 SBI)。在基层医疗机构实施酒精筛查和简短行为干预时,在调整程序和基础设施以支持其常规实施方面遇到了许多障碍。本案例集介绍了由美国疾病控制与预防中心资助的 4 个学术卫生系统团队所采用的实施策略,这些团队在医疗保健系统中实施酒精 SBI 以预防酒精暴露妊娠:方法:我们使用了 "报告适应性和修改性扩展框架"(FRAME)中的结构来描述对实施策略的计划内和计划外适应性,并使用了 "SBIRT(筛查、简单干预和转诊治疗)计划矩阵 "来确定关键问题、挑战和改进酒精SBI实施的建议。参与系统包括一家全国性生殖保健组织的两个地区分支机构、一家综合非营利性医疗保健系统、一家城市医疗中心及其附属的社区保健中心网络:计划内的调整包括扩大简短干预的目标人群,将可能怀孕的低水平饮酒患者纳入其中,修改工作流程和系统以支持常规筛查,以及定制培训内容和后勤服务。计划外的调整包括:改变现场招募和实施前的意识培养策略,以提高分散管理的系统在当地的接受能力,以及在 COVID-19 大流行期间将现场培训转为虚拟培训。在集中管理结构和实践团队全面参与实施规划、培训、推广和问题解决的医疗系统中,计划外的调整较少:在 4 个案例中都观察到了计划外的调整,强调了在动态环境中实施循证实践时灵活、适应性设计的重要性。医疗系统参与规划,包括决定修改电子健康记录和工作流程,有助于适应意外情况,实现实施目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信