Implementation science communications最新文献

{"title":"Lowering the burden: Shorter versions of the Program Sustainability Assessment Tool (PSAT) and Clinical Sustainability Assessment Tool (CSAT).","authors":"Sara Malone, Kim Prewitt, Virginia McKay, Luke Zabotka, Caren Bacon, Douglas A Luke","doi":"10.1186/s43058-024-00656-y","DOIUrl":"10.1186/s43058-024-00656-y","url":null,"abstract":"<p><strong>Background: </strong>Although significant advances have been made in the conceptualization of sustainability, having pragmatic, psychometrically valid tools remains a need within the field. Our previous work has developed frameworks and tools to assess both program sustainability and clinical sustainability capacity. This work presents new, psychometrically tested short versions of the Program Sustainability Assessment Tool (PSAT) and the Clinical Sustainability Assessment Tool (CSAT).</p><p><strong>Methods: </strong>These methods were conducted in identical, parallel processes for the CSAT and PSAT. Previously collected data for these instruments was obtained across a variety of settings, contexts, and participants. We first conducted testing to determine cronbach's alpha of shortened domains (3 items each) and then conducted Confirmatory Factor Analysis to ensure that the domains were still appropriate for the tool. After, the team met to review the results and determine the final versions of the short PSAT and short CSAT.</p><p><strong>Results: </strong>The short PSAT retained cronbach's alpha's of 0.82 - 0.91 for each domain of the tool, with which maintains excellent reliability for the tool. Confirmatory factor analysis highlights that the short PSAT retains conceptual distinction across the 8 domains, with CFI scores greater than 0.90, RMSEA scores below 0.6, and SRMR scores less than 0.08. The short CSAT had cronbach's alpha of 0.84 - 0.92 for each of the domains of the tool, also suggesting excellent reliability of the domains within the measure after dropping two items/domain. Confirmatory factor analysis of the short CSAT meets the same specifications as above, again highlighting conceptual distinction across the domains.</p><p><strong>Conclusion: </strong>Each tool was able to be shortened to three items per domain while maintaining strong psychometric properties. This results in a tool that takes less time to complete, meeting one of the key calls for pragmatic measures within implementation science. This advances our abilities to measure and test sustainability within implementation science.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"113"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and enablers to addressing smoking, nutrition, alcohol consumption, physical activity and gestational weight gain (SNAP-W) as part of antenatal care: A mixed methods systematic review.","authors":"Sophie Dilworth, Emma Doherty, Carly Mallise, Milly Licata, Jenna Hollis, Olivia Wynne, Cassandra Lane, Luke Wolfenden, John Wiggers, Melanie Kingsland","doi":"10.1186/s43058-024-00655-z","DOIUrl":"10.1186/s43058-024-00655-z","url":null,"abstract":"<p><strong>Background: </strong>International clinical guidelines recommend that smoking, nutrition, alcohol consumption, physical activity and gestational weight gain (SNAP-W) be addressed as part of routine antenatal care throughout pregnancy. However, guideline recommendations are poorly implemented, and few antenatal care recipients routinely receive the recommended care. There is a need to establish the determinants (barriers and enablers) to care delivery to inform strategies to improve implementation. This systematic review aimed to synthesize qualitative and quantitative evidence of the barriers and enablers to the routine delivery of antenatal care targeting SNAP-W health risks.</p><p><strong>Methods: </strong>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases were searched for relevant studies published between January 2001 and November 2023. Study findings were coded and analysed according to the domains of the Theoretical Domains Framework (TDF).</p><p><strong>Results: </strong>Forty-nine studies were included in the review, 27 qualitative studies and 22 quantitative studies. The studies were conducted in 14 countries. Data were collected from 7146 antenatal care providers (midwives, Aboriginal health workers, obstetricians, medical officers, general practitioners) and 352 barriers and enablers were identified. Across all SNAP-W health risk and antenatal care provider groups, the predominant TDF domain was 'environmental context and resources', identified in 96% of studies. Barriers within this domain included insufficient time, limited access to and quality of resources, and limited organisational supports. 'Beliefs about consequences' was the second most common TDF domain, reported in 67% of studies, particularly studies of care related to alcohol use, nutrition/ physical activity/ gestational weight gain and those involving midwives, multidisciplinary practitioners and general practitioners. 'Optimism' was the second most common TDF domain for studies of smoking-related care and involving obstetricians, gynaecologists, and other mixed medical professions.</p><p><strong>Conclusions: </strong>It is critical that determinants related to environmental context and resources including time, resources and organisational supports are considered in the development of strategies to support the implementation of recommended antenatal care related to SNAP-W risks. Strategies addressing clinician beliefs about consequences and optimism may also be needed to support the implementation of care related to specific health behaviours and by specific antenatal care provider groups.</p><p><strong>Registration: </strong>The review protocol was prospectively registered with Prospero: CRD42022353084; 22 October 2022.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"112"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process mapping with failure mode and effects analysis to identify determinants of implementation in healthcare settings: a guide.","authors":"Eric J Roseen, Anna Natrakul, Bo Kim, Sarabeth Broder-Fingert","doi":"10.1186/s43058-024-00642-4","DOIUrl":"https://doi.org/10.1186/s43058-024-00642-4","url":null,"abstract":"<p><strong>Background: </strong>Generating and analyzing process maps can help identify and prioritize barriers to the implementation of evidence-based practices in healthcare settings. Guidance on how to systematically apply and report these methods in implementation research is scant. We describe a method combining a qualitative approach to developing process maps with a quantitative evaluation of maps drawn from the quality improvement literature called failure mode and effects analysis (FMEA).</p><p><strong>Methods: </strong>We provide an outline and guidance for how investigators can use process mapping with FMEA to identify and prioritize barriers when implementing evidence-based clinical interventions. Suggestions for methods and reporting were generated based on established procedures for process mapping with FMEA and through review of original research papers which apply both methods in healthcare settings. We provide case examples to illustrate how this approach can be operationalized in implementation research.</p><p><strong>Results: </strong>The methodology of process mapping with FMEA can be divided into four broad phases: 1) formulating a plan, 2) generating process maps to identify and organize barriers over time, 3) prioritizing barriers through FMEA, and 4) devising an implementation strategy to address priority barriers. We identified 14 steps across the four phases. Two illustrative examples are provided. Case 1 describes the implementation of referrals to chiropractic care for adults with low back pain in primary care clinics. Case 2 describes the implementation of a family navigation intervention for children with autism spectrum disorder seeking care in pediatric clinics. For provisional guidance for reporting, we propose the REporting Process mapping and Analysis for Implementation Research (REPAIR) checklist.</p><p><strong>Conclusions: </strong>Process mapping with FMEA can elucidate barriers and facilitators to successful implementation of evidence-based clinical interventions. This paper provides initial guidance for more systematic applications of this methodology in implementation research. Future research should use a consensus-building approach, such as a multidisciplinary Delphi panel, to further delineate the reporting standards for studies that use process mapping with FMEA.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"110"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation and implementation determinants of HIV testing and linkage-to-care in the U.S.: a systematic review.","authors":"Alithia Zamantakis, James L Merle, Artur Afln Queiroz, Juan Pablo Zapata, Jasmine Deskins, Ana Michaela Pachicano, Melissa Mongrella, Dennis Li, Nanette Benbow, Carlos Gallo, J D Smith, Brian Mustanski","doi":"10.1186/s43058-024-00638-0","DOIUrl":"10.1186/s43058-024-00638-0","url":null,"abstract":"<p><strong>Objective: </strong>To identify innovation and implementation determinants of HIV testing, diagnosis, and linkage-to-care in the U.S.</p><p><strong>Data sources and study setting: </strong>Between November 2020 and January 2022, a broad search strategy was employed in three literature databases: Ovid MEDLINE, PsycINFO, and Web of Science.</p><p><strong>Study design: </strong>A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.</p><p><strong>Data collection/extraction methods: </strong>A team of master's and Ph.D.-level researchers screened eligible studies against the inclusion criteria and extracted the data using COVIDENCE software in pairs with consensus performed by a senior member of the team. Barriers and facilitators were extracted and analyzed according to the Consolidated Framework for Implementation Research (CFIR). Frequency of determinants across studies was mapped according to CFIR, valence, study design, delivery setting, unit of analysis, population of interest, region of the U.S., and year.</p><p><strong>Results: </strong>We identified 1,739 implementation and innovation determinants from 186 articles. Most determinants were for HIV testing rather than linkage-to-care. Most determinants were identified in the inner setting and individuals domains of CFIR, with the fewest identified in the process and innovations domains. Determinants of providers were only slightly more frequently identified than determinants of recipients. However, determinants of organizations and systems were rarely identified.</p><p><strong>Conclusion: </strong>This review provides a synthesis of innovation and implementation determinants of HIV testing and linkage-to-care using the most-cited implementation science (IS) framework, CFIR. This synthesis enables the larger field of HIV science to utilize IS in efforts to end the HIV epidemic and positions IS to consider the application of IS frameworks to fields like HIV.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"111"},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convenings as a tool for enhancing implementation strategies: lessons from the Black Women First initiative.","authors":"Melanie Rocco, Madison Kitchen, Cecilia Flores-Rodriguez, Alicia Downes, Judith C Scott, Serena Rajabiun, Angela Wangari Walter, Linda Sprague Martinez","doi":"10.1186/s43058-024-00652-2","DOIUrl":"10.1186/s43058-024-00652-2","url":null,"abstract":"<p><strong>Background: </strong>The Expert Recommendations for Implementing Change (ERIC) project identified 73 strategies for supporting the implementation of a novel intervention and evidence-informed practices. In this paper, we explore convenings, which engage stakeholders in proactive dialogues, as a mechanism to deliver multiple strategies that support sites adapting and implementing evidence-informed bundled interventions for Black women with HIV.</p><p><strong>Methods: </strong>We use an instrumental case study design to explore strategies embedded in biannual convenings hosted by the Black Women First Initiative (BWF) Evaluation and Technical Assistance Provider (ETAP). Data sources including planning documents, direct observation of the convenings and analysis of convening attendee feedback surveys were analyzed.</p><p><strong>Results: </strong>Using instrumental case study design, we found that convenings were a helpful tool that allowed for cross-site communication and collaboration. Communal re-examination of implementation strategies, coupled with training and network-weaving, created a rich learning environment to identify potential intervention adaptations and changes, unify on data collection, and prepare to test these adaptations at each respective site.</p><p><strong>Conclusions: </strong>We discuss lessons learned when using convenings to help health care and community-based settings collectively explore and address adaptation and implementation barriers as they implement evidence-informed interventions to improve health outcomes for populations affected by chronic conditions, such as HIV.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"109"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation.","authors":"Christian J Lopez, Sarah E Neil-Sztramko, Mounir Tanyoas, Kristin L Campbell, Jackie L Bender, Gillian Strudwick, David M Langelier, Tony Reiman, Jonathan Greenland, Jennifer M Jones","doi":"10.1186/s43058-024-00650-4","DOIUrl":"10.1186/s43058-024-00650-4","url":null,"abstract":"<p><strong>Background: </strong>Electronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.</p><p><strong>Methods: </strong>Implementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy's feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.</p><p><strong>Results: </strong>Of the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.</p><p><strong>Conclusion: </strong>We present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"108"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing NIH Community Implementation Programs to improve maternal health.","authors":"Karen M Plevock Haase, Candice A Price, Gina S Wei, Ilana G Goldberg, Bryan C Ampey, Erynn A Huff, Kimberly R Durkin, Ashley E Blair, Camille A Fabiyi, Keisher S Highsmith, Melissa S Wong, David Clark, George A Mensah","doi":"10.1186/s43058-024-00634-4","DOIUrl":"10.1186/s43058-024-00634-4","url":null,"abstract":"<p><p>The United States has seen increasing trends of maternal mortality in recent years. Within this health crisis there are large disparities whereby underserved and minoritized populations are bearing a larger burden of maternal morbidity and mortality. While new interventions to improve maternal health are being developed, there are opportunities for greater integration of existing evidence-based interventions into routine practice, especially for underserved populations, including those residing in maternity care deserts. In fact, over 80 percent of maternal deaths are preventable with currently available interventions. To spur equitable implementation of existing interventions, the National Heart, Lung, and Blood Institute launched the Maternal-Health Community Implementation Program (MH-CIP) in 2021. In 2023, the National Institutes of Health's Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative partnered with the NHLBI to launch the IMPROVE Community Implementation Program (IMPROVE-CIP). By design, CIPs engage disproportionately impacted communities and partner with academic researchers to conduct implementation research. This commentary overviews the impetus for creating these programs, program goals, structure, and offers a high-level overview of the research currently supported. Lastly, the potential outcomes of these programs are contextualized within the landscape of maternal health initiatives in the United States.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"105"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-exposure Prophylaxis (PrEP) implementation among latino MSM: a qualitative scoping review of implementation determinants and change methods.","authors":"Juan Pablo Zapata, Alithia Zamantakis, Artur Queiroz, James L Merle, Nanette Benbow, Brian Mustanski","doi":"10.1186/s43058-024-00645-1","DOIUrl":"10.1186/s43058-024-00645-1","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing rates of HIV among Latino men who have sex with men (MSM) necessitate innovative and rigorous studies to evaluate prevention and treatment strategies. Pre-exposure prophylaxis (PrEP) is a highly effective tool in preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the U.S. initiative. However, there is a scarcity of PrEP research specifically focused on Latino MSM, and the factors influencing its implementation remain largely unknown.</p><p><strong>Methods: </strong>To address this gap, we conducted a comprehensive review exploring the determinants (barriers and facilitators) of PrEP implementation among Latino MSM, as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to promote its adoption. Our review encompassed 43 peer-reviewed articles examining determinants and four articles assessing change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR 2.0) to understand the multilevel barriers and facilitators associated with implementation.</p><p><strong>Results: </strong>The majority of research has focused on PrEP recipients (i.e., patients), primarily examining their awareness and willingness to use PrEP. Fewer studies have explored the factors influencing clinicians and service delivery systems. Additionally, the evaluation of change methods to enhance clinician adoption and adherence to PrEP and recipient adherence to PrEP has been limited.</p><p><strong>Conclusion: </strong>It is evident that there is a need for culturally adapted strategies tailored specifically for Latino MSM, as the current literature remains largely unexplored in this regard. By incorporating principles from implementation science, we can gain a clearer understanding of the knowledge, skills, and roles necessary for effective cultural adaptations. Future research should emphasize factors influencing implementation from a clinician standpoint and focus on innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence among Latino MSM.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"107"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description.","authors":"Karen M Benzies, Pilar Zanoni, Deborah A McNeil","doi":"10.1186/s43058-024-00644-2","DOIUrl":"10.1186/s43058-024-00644-2","url":null,"abstract":"<p><strong>Background: </strong>Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care.</p><p><strong>Methods: </strong>This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study.</p><p><strong>Results: </strong>To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system.</p><p><strong>Conclusions: </strong>We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"106"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11441001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department buprenorphine program: staff concerns and recommended implementation strategies.","authors":"Olufemi Ajumobi, Sarah Friedman, Michelle Granner, Julie Lucero, John Westhoff, Brandon Koch, Karla D Wagner","doi":"10.1186/s43058-024-00649-x","DOIUrl":"https://doi.org/10.1186/s43058-024-00649-x","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting to Emergency Departments (ED) with opioid use disorder may be candidates for buprenorphine treatment, making EDs an appropriate setting to initiate this underused, but clinically proven therapy. Hospitals are devoting increased efforts to routinizing buprenorphine initiation in the ED where clinically appropriate, with the greatest successes occurring in academic medical centers. Overall, however, clinician participation in these efforts is suboptimal. Hospitals need more information to inform the standardized implementation of these programs nationally. Using an implementation science framework, we investigated ED providers' concerns about ED buprenorphine programs and their willingness to prescribe buprenorphine in the ED.</p><p><strong>Methods: </strong>We conducted Consolidated Framework for Implementation Research (CFIR)-informed interviews with 11 ED staff in Nevada and analyzed the transcripts using a six-step thematic approach. Results were organized within the CFIR 1.0 domains of inner setting, outer setting, intervention characteristics, and individual characteristics; potential implementation strategies were recommended.</p><p><strong>Results: </strong>Physicians expressed that the ED is a suitable location for prescribing buprenorphine. However, they expressed concerns about: information gaps in the prescribing protocols (inner setting), patient outcomes beyond the ED, buprenorphine effectiveness and appropriate timing of treatment initiation (intervention characteristics), and their own competence in managing opioid withdrawal (individual characteristics). Some were anxious about patients' outcomes and continuity of care in the community (outer setting), others desired access to prospective data that demonstrate buprenorphine effectiveness. Additional concerns included a lack of availability of the required support to prescribe buprenorphine, a lack of physicians' experience and competence, and concerns about opioid withdrawal. Recommended implementation strategies to address these concerns include: designating personnel at the ED to bridge the information gap, engaging emergency physicians through educational meetings, creating a community of practice, facilitating mentorship opportunities, and leveraging existing collaborative learning platforms.</p><p><strong>Conclusion: </strong>Overall, physicians in our study believed that implementing a buprenorphine program in the ED is appropriate, but had concerns. Implementation strategies could be deployed to address concerns at multiple levels to increase physician willingness and program uptake.</p>","PeriodicalId":73355,"journal":{"name":"Implementation science communications","volume":"5 1","pages":"104"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11429138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}