Alcohol Use Disorder Pharmacotherapy and Treatment in Primary Care (Adapt-Pc) Trial: Impact on Identified Barriers to Implementation

Background: A minority of individuals meeting diagnostic criteria for alcohol use disorders (AUD) receive any type of formal treatment. Developing options for AUD treatment within primary care settings is imperative to increase treatment access. A multi-faceted implementation intervention including provider and patient education, clinician reminders, development of local champions and ongoing facilitation was designed to enhance access to AUD pharmacotherapy in primary care settings at three large Veterans Health Administration (VHA) facilities. This qualitative study compared pre-implementation barriers to post-implementation barriers identified via provider interviews to identify those barriers addressed and not addressed by the intervention to better understand the limited impact of the intervention. Methods: Following the nine-month implementation period, primary care providers at the three participating facilities took part in qualitative interviews to collect perceptions regarding which pre-implementation barriers had and had not been successfully addressed by the intervention. Participants included 20 primary care providers from three large VHA facilities. Interviews were coded using common coding techniques for qualitative data using the Consolidated Framework for Implementation Research (CFIR) codebook. Summary reports were created for each CFIR construct for each facility and the impact of each CFIR construct on implementation was coded as positive, neutral, or negative. Results: Some barriers identified during pre-implementation interviews were no longer identified as barriers in the post-implementation interviews. These included Relative Advantage, Relative Priority, and Knowledge & Beliefs about the Innovation. However, Compatibility, Design Quality & Packaging, and Available Resources remained barriers at the end of the implementation period. No substantial new barriers were identified. Conclusions: The implementation intervention appears to have been successful at addressing barriers that could be mitigated with traditional educational approaches. However, the intervention did not adequately address structural and organizational barriers to implementation. Recommendations for enhancing future interventions are provided.

背景：少数符合酒精使用障碍（AUD）诊断标准的个体接受了任何形式的正规治疗。在初级医疗环境中开发AUD治疗方案对于增加治疗可及性至关重要。一项多层面的实施干预措施，包括对医疗服务提供者和患者的教育、临床医生提醒、培养当地倡导者以及持续的促进措施，旨在提高三个大型退伍军人健康管理局（VHA）机构的初级医疗环境中AUD药物治疗的可及性。这项定性研究比较了通过医疗服务提供者访谈确定的实施前障碍和实施后障碍，以确定干预措施解决了哪些障碍以及未解决哪些障碍，从而更好地理解干预措施的有限影响。 方法：在为期九个月的实施期之后，三个参与机构的初级医疗服务提供者参加了定性访谈，以收集关于干预措施成功解决和未成功解决哪些实施前障碍的看法。参与者包括来自三个大型VHA机构的20名初级医疗服务提供者。使用《实施研究综合框架》（CFIR）编码手册，采用定性数据的常用编码技术对访谈进行编码。为每个机构的每个CFIR结构创建了总结报告，并将每个CFIR结构对实施的影响编码为积极、中性或消极。 结果：在实施前访谈中确定的一些障碍在实施后访谈中不再被视为障碍。这些障碍包括相对优势、相对优先级以及对创新的知识和信念。然而，兼容性、设计质量与包装以及可用资源在实施期结束时仍然是障碍。没有发现大量新的障碍。 结论：实施干预措施似乎在解决可以通过传统教育方法缓解的障碍方面取得了成功。然而，该干预措施没有充分解决实施的结构和组织障碍。文中提供了增强未来干预措施的建议。