使事情发生:需要实施研究

IF 1.4 Q3 PSYCHIATRY
A. Reupert
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Given that implementation science is about prompting the uptake of evidence-based interventions into routine care, implementation plans need to incorporate and address the preference and needs of individual clients, the interests and capacities of clinicians, systemic issues related to leadership, organisations and policy, and the nature of the communities in which the initiative is being delivered (Grant & Reupert, 2016; Grant et al., 2019). Thus, strategies for introducing the vaccine will need to grapple with the varied nature of healthcare and community settings, and encourage uptake to the public, some of whom maybe suspicious or fearful. Embedding new initiatives into routine care is not easy however and implementation issues, sometimes portrayed as the research-practice chasm, have existed for some time. 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Such efforts can be challenging given the many and often competing funding demands for essential tertiary services. However, I would argue that constrained funding in the area of prevention, promotion and early intervention is a false economy given the direct costs of treating someone with a mental illness and indirect costs of unemployment, sick leave, income support payments and the incarceration or homelessness sometimes resulting from mental health issues (Reupert, 2020). It is within this context that implementation science needs to be a core component of our mental health promotion, prevention, and early intervention work. The present issue provides much guidance regarding how to integrate research findings and evidence into healthcare policy and practice, or in other words, how tomake ‘things’ happen. In the first instance, the need for long-term planning is highlighted by several papers. Woodhead et al. 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What has become very obvious however, is an absence of a systematic plan for rolling out the vaccine to the public. Implementation science is an important consideration in this regard, defined as promoting the ‘systematic uptake of research findings and other evidence-based practices into routine practice’ that serves to ‘improve the quality and effectiveness of health services’ (Eccles & Mittman, 2006, p. 1). Given that implementation science is about prompting the uptake of evidence-based interventions into routine care, implementation plans need to incorporate and address the preference and needs of individual clients, the interests and capacities of clinicians, systemic issues related to leadership, organisations and policy, and the nature of the communities in which the initiative is being delivered (Grant & Reupert, 2016; Grant et al., 2019). 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引用次数: 4

摘要

关于COVID-19对我们的经济、医院、工作场所、学校以及我们的身心健康的不利影响,已经写了很多文章。面对这些前所未有的问题,人们急于开发一种疫苗,作为平息大流行及其后果的一剂良药。然而,已经变得非常明显的是,缺乏向公众推广疫苗的系统计划。在这方面,实施科学是一个重要的考虑因素,它被定义为促进“系统地将研究结果和其他循证实践纳入常规实践”,从而“提高卫生服务的质量和有效性”(Eccles & Mittman, 2006年,第1页)。鉴于实施科学是关于促进将循证干预措施纳入常规护理,实施计划需要纳入并解决个人客户的偏好和需求、临床医生的兴趣和能力、与领导力、组织和政策相关的系统性问题,以及倡议实施所在社区的性质(Grant & Reupert, 2016;Grant et al., 2019)。因此,引进疫苗的战略将需要努力应对卫生保健和社区环境的不同性质,并鼓励公众接受,其中一些人可能会怀疑或害怕。然而,将新举措纳入常规护理并不容易,实施问题(有时被描述为研究与实践的鸿沟)已经存在了一段时间。在2010年,Fixsen和他的同事们写道,“有效的干预措施的使用规模足以使社会受益,这需要仔细关注实施策略……一种没有另一种,就像血清没有注射器:可以治愈,但不能提供”(2010年,第448页)。在这个时代,从来没有说过比这更真实的话。本刊的主旨是早期干预,预防精神疾病和促进精神健康和福祉。所有这三个重点都需要长期规划,考虑到如何、何时、何地向不同人群提供不同的精神卫生倡议。有效实施不仅仅是制定基于证据的干预措施或提供干预措施。需要一个社区,广泛的生态观点,包括政策和管理,通常需要对基础设施,人员配置和资源进行重大改变(Tchernegovski等人,2018)。鉴于对基本三级服务的许多且往往相互竞争的资金需求,这种努力可能具有挑战性。然而,我认为,鉴于治疗精神疾病患者的直接成本和失业、病假、收入支持支付以及有时由精神健康问题引起的监禁或无家可归的间接成本,在预防、促进和早期干预领域的资金限制是一种虚假的经济(Reupert, 2020)。正是在这种背景下,实施科学需要成为我们心理健康促进、预防和早期干预工作的核心组成部分。目前的问题提供了很多关于如何将研究结果和证据纳入医疗保健政策和实践的指导,或者换句话说,如何使“事情”发生。首先,几篇论文强调了长期规划的必要性。Woodhead等人(2021)强调了运动生理学在青少年心理健康环境中的价值,以及对资源和长期可持续性的需求。Vivekananda et al.,(2021)提供了一个
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Making things happen: the need for implementation research
Much has been written about the adverse impacts from COVID-19, on our economies, hospitals, workplaces, schools and to our mental and physical health. In the face of these unprecedented problems, there has been a rush to develop a vaccine, as a salve to quell the pandemic and its resulting fallout. What has become very obvious however, is an absence of a systematic plan for rolling out the vaccine to the public. Implementation science is an important consideration in this regard, defined as promoting the ‘systematic uptake of research findings and other evidence-based practices into routine practice’ that serves to ‘improve the quality and effectiveness of health services’ (Eccles & Mittman, 2006, p. 1). Given that implementation science is about prompting the uptake of evidence-based interventions into routine care, implementation plans need to incorporate and address the preference and needs of individual clients, the interests and capacities of clinicians, systemic issues related to leadership, organisations and policy, and the nature of the communities in which the initiative is being delivered (Grant & Reupert, 2016; Grant et al., 2019). Thus, strategies for introducing the vaccine will need to grapple with the varied nature of healthcare and community settings, and encourage uptake to the public, some of whom maybe suspicious or fearful. Embedding new initiatives into routine care is not easy however and implementation issues, sometimes portrayed as the research-practice chasm, have existed for some time. In 2010, Fixsen and colleagues wrote, ‘the use of effective interventions on a scale sufficient to benefit society requires careful attention to implementation strategies...One without the other is like serum without a syringe: the cure is available but the delivery is not’ (2010, p. 448). Never have truer words been spoken in these present times. The brief of this journal is early intervention, the prevention of mental illness and the promotion of mental health and wellbeing. All three foci demand long-term planning that takes into consideration how, when and where different mental health initiatives can be delivered to different population groups. Effective implementation is more than developing an evidencebased intervention or making an intervention available. A community, broad ecological view is required, that incorporates policy and management, often necessitating major changes to infrastructure, staffing and resourcing (Tchernegovski et al., 2018). Such efforts can be challenging given the many and often competing funding demands for essential tertiary services. However, I would argue that constrained funding in the area of prevention, promotion and early intervention is a false economy given the direct costs of treating someone with a mental illness and indirect costs of unemployment, sick leave, income support payments and the incarceration or homelessness sometimes resulting from mental health issues (Reupert, 2020). It is within this context that implementation science needs to be a core component of our mental health promotion, prevention, and early intervention work. The present issue provides much guidance regarding how to integrate research findings and evidence into healthcare policy and practice, or in other words, how tomake ‘things’ happen. In the first instance, the need for long-term planning is highlighted by several papers. Woodhead et al. (2021) highlight the value of exercise physiology within youth mental health settings and the need for resourcing and long-term sustainability. Vivekananda et al., (2021) provide a
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3.20
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