Mis-implementation of evidence-based behavioural health practices in primary care: lessons from randomised trials in Federally Qualified Health Centers

被引：0

作者：

Dopp, Alex R. ^{[1
]}

Hindmarch, Grace ^{[1
]}

Osilla, Karen Chan ^{[2
]}

Meredith, Lisa S. ^{[1
]}

Manuel, Jennifer K. ^{[3
,4
]}

Becker, Kirsten ^{[1
]}

Tarhuni, Lina ^{[5
]}

Schoenbaum, Michael ^{[6
]}

Komaromy, Miriam ^{[7
]}

Cassells, Andrea ^{[8
]}

Watkins, Katherine E. ^{[1
]}

机构：

[1] RAND Corp, Santa Monica, CA 90406 USA

[2] Stanford Univ, Stanford, CA 94305 USA

[3] Univ Calif San Francisco, San Francisco, CA 94143 USA

[4] San Francisco VA Hlth Care Syst, San Francisco, CA USA

[5] Univ Washington, Seattle, WA 98195 USA

[6] NIMH, Bethesda, MD 20892 USA

[7] Boston Univ, Boston, MA 02215 USA

[8] Clin Directors Network Inc, New York, NY USA

来源：

EVIDENCE & POLICY | 2024年 / 20卷 / 01期

关键词：

mis-implementation; primary care; behavioural health; Federally Qualified Health Center;

D O I：

暂无

中图分类号：

C [社会科学总论];

学科分类号：

03 ; 0303 ;

摘要：

Background: Implementing evidence -based practices (EBPs) within service systems is critical to population -level health improvements, but also challenging, especially for complex behavioural health interventions in low -resource settings. 'Mis-implementation' refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange. Aims and objectives: We present mis-implementation cases from three pragmatic trials of behavioural health EBPs in US Federally Qualified Health Centers (FQHCs). Methods: We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors. Findings: Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy -in from overburdened providers, lack of alignment between providers and leadership, and COVID19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider -level barriers, and that were conducted during the COVID-19 pandemic. Discussion and conclusion: Multilevel determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimise mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site -specific contextual factors, and should be tailored to relevant audiences such as providers, patients, and/or leadership.

引用

页码：15 / 35

页数：21