From policy to practice: implementing frontline community health services for substance dependence–study protocol

Implementation Science

Ann C Macaulay³  Dara Charney²  Spyridoula Xenocostas⁴  Gail Gauthier¹  Emily Campbell¹  Kathryn J Gill² 

[1] Addictions Unit, McGill University Health Centre, 1547 Pine Avenue West, Montreal, Quebec, Canada;Psychiatry Department, McGill University, 1033 Pine Avenue West, Montreal, Quebec, Canada;Participatory Research at McGill, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, 3rd floor, Montreal, Quebec, Canada;Centre de Santé et de Services Sociaux de la Montagne, 1801 Boulevard de Maisonneuve Ouest, 6e étage, Montréal, Québec, Canada

关键词: Organizational change;    Policy;    Knowledge translation;    Implementation;    Frontline health services;    Brief interventions;    Screening;    Substance dependence;   

Others  :  1146743
DOI  :  10.1186/s13012-014-0108-x

 received in 2014-07-22, accepted in 2014-08-11,  发布年份 2014

【 摘 要 】

Background

Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2).

Methods/Design

Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.

Discussion

Findings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

【 授权许可】

   
2014 Gill et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1][http://www.drugabuse.gov/related-topics/trends-statistics#costs] webcite Trends and Statistics- Costs of Substance Abuse.? ?, ?:? []
• [2]Rehm J, Gnam W, Popova S, Baliunas D, Brochu S, Fischer B, Patra J, Sarnocinska-Hart A, Taylor B: The costs of alcohol, illegal drugs, and tobacco in Canada, 2002. J Stud Alcohol Drugs 2007, 68:886.
• [3]Weisner C, Parthasarathy S, Moore C, Mertens JR: Individuals receiving addiction treatment: are medical costs of their family members reduced? Addiction 2010, 105:1226-1234.
• [4]Mundt MP: Analyzing the costs and benefits of brief intervention. Alcohol Res Health 2006, 29:34-36.
• [5]McCollister KE, French MT: The relative contribution of outcome domains in the total economic benefit of addiction interventions: a review of first findings. Addiction 2003, 98:1647-1659.
• [6]Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, Grol R, Gual A, Pas L: Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol 2004, 39:351-356.
• [7]Edlund MJ, Unutzer J, Wells KB: Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities. Med Care 2004, 42:1158-1166.
• [8]Neushotz LA, Fitzpatrick JJ: Improving substance abuse screening and intervention in a primary care clinic. Arch Psychiatr Nurs 2008, 22:78-86.
• [9]Ballesteros J, Duffy JC, Querejeta I, Arino J, Gonzalez-Pinto A: Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Alcohol Clin Exp Res 2004, 28:608-618.
• [10][http://www.sbir-diba.ca] webcite Alcohol screening, brief intervention and referral: helping patients reduce alcohol-related risks and harms. ,[]
• [11]Heather N: WHO Collaborative Project on Identification and Management of Alcohol-Related Problems in Primary Health Care. Report on Phase IV: Development of Country-Wide Strategies for Implementing Early Identification and Brief Intervention in Primary Health Care. WHO, Geneva; 2006.
• [12]Martin G, Copeland J: The adolescent cannabis check-up: randomized trial of a brief intervention for young cannabis users. J Subst Abuse Treat 2008, 34:407-414.
• [13]Whitlock EP, Polen MR, Green CA, Orleans T, Klein J: Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004, 140:557-568.
• [14]Moyer A, Finney JW, Swearingen CE, Vergun P: Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002, 97:279-292.
• [15]Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwutikarn J, De Lacerda RB, Ling W, Marsden J, Monteiro M, Nhiwhatiwa S, Pal H, Poznyak V, Simon S: Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction 2008, 103:1039-1047.
• [16]Grol R: Knowledge transfer in mental health care: how do we bring evidence into day-to-day practice? Can J Psychiatry 2008, 53:275-276.
• [17]Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J: Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus 2007, 28:7-30.
• [18]Heather N: A long-standing World Health Organization collaborative project on early identification and brief alcohol intervention in primary health care comes to an end. Addiction 2007, 102:679-681.
• [19]Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007, 2:Cd004148.
• [20][http:/ / pubs.niaaa.nih.gov/ publications/ Practitioner/ CliniciansGuide2005/ guide.pdf] webcite Helping patients who drink too much: A clinician¿s guide (Updated 2005)., []
• [21]Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak V, Monteiro M: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for use in primary care. World Health Organisation, Geneva; 2010.
• [22]Davis D, Evans M, Jadad A, Perrier L, Rath D, Ryan D, Sibbald G, Straus S, Rappolt S, Wowk M, Zwarenstein M: The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003, 327:33-35.
• [23]Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006, 26:13-24.
• [24]Goering P, Boydell KM, Pignatiello A: The relevance of qualitative research for clinical programs in psychiatry. Can J Psychiatry 2008, 53:145-151.
• [25]Unis dans l¿action: Plan d¿action interministeriel en toxicomanie 2006¿2011. Ministère de la Santé et des Services Sociaux (Ministry of Health and Social Services), Québec; 2006.
• [26]Unis dans l¿action: Offre de service 2007¿2012-Programme-services Dépendances: Orientations relatives aux standards d¿accès, de continuité, de qualité, d¿efficacité et d¿efficience. Ministère de la Santé et des Services Sociaux (Ministry of Health and Social Services), Québec; 2007.
• [27]Plan stratégique pour les services de la santé et des services sociaux 2005¿2010. Ministère de la Santé et des Services Sociaux (Ministry of Health and Social Services), Québec; 2005.
• [28][http://cihr-irsc.gc.ca/e/39033.html] webcite More about Knowledge Translation at CIHR. []
• [29][http://www.cihr-irsc.gc.ca/e/44954.html] webcite A Guide to Researcher and Knowledge-User Collaboration in Health Research. []
• [30]Cargo M, Mercer SL: The value and challenges of participatory research: strengthening its practice. Annu Rev Public Health 2008, 29:325-350.
• [31]Jagosh J, Macaulay AC, Pluye P, Salsberg J, Bush PL, Henderson J, Sirett E, Wong G, Cargo M, Herbert CP, Seifer SD, Green LW, Greenhalgh T: Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q 2012, 90:311-346.
• [32]Daley BJ: Learning and professional practice: a study of four professions. Adult Educ Q 2001, 52:39-54.
• [33]Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J: How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q 2003, 81:221-248. 171¿222
• [34]Ho K, Bloch R, Gondocz T, Laprise R, Perrier L, Ryan D, Thivierge R, Wenghofer E: Technology-enabled knowledge translation: frameworks to promote research and practice. J Contin Educ Health Prof 2004, 24:90-99.
• [35]Lavis JN: Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges. J Contin Educ Health Prof 2006, 26:37-45.
• [36]Logan J, Graham ID: Toward a comprehensive interdisciplinary model of health care research use. Sci Commun 1998, 20:227-246.
• [37]Graham ID, Logan J: Innovations in knowledge transfer and continuity of care. Can J Nurs Res 2004, 36:89-103.
• [38]Sandelowski M: Whatever happened to qualitative description? Res Nurs Health 2000, 23:334-340.
• [39]Ritchie J, Spencer L: Qualitative Data Analysis for Applied Policy Research. Routledge, London; 1993.
• [40]Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res 2004, 6:61-74.
• [41]Aarons GA, McDonald EJ, Sheehan AK, Walrath-Greene CM: Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale in a geographically diverse sample of community mental health providers. Adm Policy Ment Health 2007, 34:465-469.
• [42]Melas CD, Zampetakis LA, Dimopoulou A, Moustakis V: Evaluating the properties of the Evidence-Based Practice Attitude Scale (EBPAS) in health care. Psychol Assess 2012, 24:867-876.
• [43]Lehman WE, Greener JM, Simpson DD: Assessing organizational readiness for change. J Subst Abuse Treat 2002, 22:197-209.
• [44]Simpson DD, Joe GW, Rowan-Szal GA: Linking the elements of change: program and client responses to innovation. J Subst Abuse Treat 2007, 33:201-209.
• [45]Simpson DD, Flynn PM: Moving innovations into treatment: a stage-based approach to program change. J Subst Abuse Treat 2007, 33:111-120.
• [46]Simpson DD: A conceptual framework for transferring research to practice. J Subst Abuse Treat 2002, 22:171-182.
• [47]Castaneda SF, Holscher J, Mumman MK, Salgado H, Keir KB, Foster-Fishman PG, Talavera GA: Dimensions of community and organizational readiness for change. Prog Community Health Partnersh 2012, 6:219-226.
• [48]Given L: The Sage Encyclopedia of Qualitative Research Methods. Sage, Thousand Oaks; 2008.