Skip to main content
main-content

01.12.2014 | Research | Ausgabe 1/2014 Open Access

Addiction Science & Clinical Practice 1/2014

An implementation-focused process evaluation of an incentive intervention effectiveness trial in substance use disorders clinics at two Veterans Health Administration medical centers

Zeitschrift:
Addiction Science & Clinical Practice > Ausgabe 1/2014
Autoren:
Hildi J Hagedorn, Cheryl B Stetler, Ann Bangerter, Siamak Noorbaloochi, Maxine L Stitzer, Daniel Kivlahan
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1940-0640-9-12) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HH conceived of the study, led the study design, interpreted data and drafted the manuscript. CS participated in the study design, provided extensive consultation on data interpretation, and provided critical revisions to the manuscript. AB developed the data collection strategies, provided database management, produced the demographic table and recruitment figure, and provided comments on the manuscript. SN participated in study design, performed statistical analyses, and provided comments on the manuscript. MS participated in study design and provided critical revisions to the manuscript. DK participated in study design and provided critical revisions to the manuscript. All authors read and approved the final manuscript.

Abstract

Background

One of the pressing concerns in health care today is the slow rate at which promising interventions, supported by research evidence, move into clinical practice. One potential way to speed this process is to conduct hybrid studies that simultaneously combine the collection of effectiveness and implementation relevant data. This paper presents implementation relevant data collected during a randomized effectiveness trial of an abstinence incentive intervention conducted in substance use disorders treatment clinics at two Veterans Health Administration (VHA) medical centers.

Methods

Participants included patients entering substance use disorders treatment with diagnoses of alcohol dependence and/or stimulant dependence that enrolled in the randomized trial, were assigned to the intervention arm, and completed a post intervention survey (n = 147). All staff and leadership from the participating clinics were eligible to participate. A descriptive process evaluation was used, focused on participant perceptions and contextual/feasibility issues. Data collection was guided by the RE-AIM and PARIHS implementation frameworks. Data collection methods included chart review, intervention cost tracking, patient and staff surveys, and qualitative interviews with staff and administrators.

Results

Results indicated that patients, staff and administrators held generally positive attitudes toward the incentive intervention. However, staff and administrators identified substantial barriers to routine implementation. Despite the documented low cost and modest staff time required for implementation of the intervention, securing funding for the incentives and freeing up any staff time for intervention administration were identified as primary barriers.

Conclusions

Recommendations to facilitate implementation are presented. Recommendations include: 1) solicit explicit support from the highest levels of the organization through, for example, performance measures or clinical practice guideline recommendations; 2) adopt the intervention incrementally starting within a specific treatment track or clinic to reduce staff and funding burden until local evidence of effectiveness and feasibility is available to support spread; and 3) educate staff about the process, goals, and value/effectiveness of the intervention and engage them in implementation planning from the start to enhance investment in the intervention.
Zusatzmaterial
Authors’ original file for figure 1
13722_2013_244_MOESM1_ESM.pdf
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2014

Addiction Science & Clinical Practice 1/2014 Zur Ausgabe