Archives: UW Articles

Abstract:

Background

Effective medications for treating alcohol use disorders (AUD) are available but underutilized. Multiple barriers to their provision have been identified, and optimal strategies for addressing and overcoming barriers to use of medications for AUD treatment remain elusive. We conducted a structured review of published care delivery and implementation studies evaluating interventions that aimed to increase medication treatment for patients with AUD to identify interventions and component strategies that were most effective.

Methods

We reviewed literature through May 2018 and used networking to identify intervention studies with AUD medication receipt reported as a primary or secondary outcome. Studies were identified as care delivery studies, characterized by patient-level recruitment and willingness to be randomized to candidate treatment options, and implementation studies, characterized by inclusion of all patients treated at sites involved in the study. Each identified study was independently coded by two investigators for strategies used, guided by a published taxonomy of implementation strategies. All authors reviewed coding discrepancies and revised codes based on consensus. After reaching internal consensus, we solicited feedback from lead investigators on studies to code additional strategies. We reviewed implementation strategies used across studies to assess their relationship with medication receipt, as well as alcohol use outcomes, as available.

Results

Nine studies were identified: four RCTs of care delivery interventions, four quasi-experimental evaluations of large-scale implementation interventions, and one quasi-experimental evaluation of a targeted single-site implementation intervention. Implementation strategies used were variable across studies; no strategy was universally used. Effects of the interventions on receipt of AUD pharmacotherapy and alcohol use outcomes also varied. Three of four care delivery interventions resulted in increased receipt of AUD medications, but only one of these three improved alcohol use outcomes. One large-scale and one single-site implementation intervention were associated with increased AUD medication receipt, and these studies did not assess alcohol use outcomes. Patterns of implementation strategies did not clearly distinguish studies that successfully increased use of pharmacotherapy versus those that did not.

Conclusions

Our review did not reveal strategies most effective for implementing AUD medications. Interventions designed to overcome identified barriers may have missed the mark, or differences in the intensity or targets of strategies may matter more than differences in strategies. Further research is needed to understand effective implementation methods and to better understand patient-level perspective, preferences and barriers to receipt of medications.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}

Abstract:

Background

Innovative approaches are needed to maximise the uptake and sustainment of evidence-based practices in a variety of health service contexts. This protocol describes a study that will seek to characterise the potential of one such approach, user-centred design (UCD), which is an emerging field that seeks to ground the design of an innovation in information about the people who will ultimately use that innovation. The use of UCD to enhance strategies for implementation of health services, although promising, requires a multidisciplinary perspective based on a firm understanding of how experts from each discipline perceives the interrelatedness and suitability of these strategies.

Method

This online study will use a combination of purposive and snowball sampling to recruit a sample of implementation experts (n = 30) and UCD experts (n = 30). These participants will each complete a concept mapping task, which is a mixed-method conceptualisation technique that will allow for identification of distinct clusters of implementation and/or UCD strategies. The research team has selected a set of implementation strategies and UCD strategies that each participant will sort and rate on dimensions of importance and feasibility. Data analyses will focus on describing the sample, identifying related clusters of strategies, and examining the convergences, divergences, and potential for collaboration between implementation science and UCD.

Discussion

By leading to a better understanding of the overlap between implementation science and UCD, grounded within established theoretical frameworks, this study holds promise for improving the impact and sustainability of evidence-based health services in community settings.

^{**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**}