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

Autor:	Dopp AR; RAND Corporation, USA., Hindmarch G; RAND Corporation, USA., Osilla KC; Stanford University School of Medicine, USA., Meredith LS; RAND Corporation, USA., Manuel JK; University of California, San Francisco, USA., Becker K; RAND Corporation, USA., Tarhuni L; University of Washington, USA., Schoenbaum M; National Institute of Mental Health, USA., Komaromy M; Boston University, USA., Cassells A; Clinical Directors Network, Inc., USA., Watkins KE; RAND Corporation, USA.
Jazyk:	angličtina
Zdroj:	Evidence & policy : a journal of research, debate and practice [Evid Policy] 2024 Feb; Vol. 20 (1), pp. 15-35. Date of Electronic Publication: 2024 Jan 08.
DOI:	10.1332/17442648y2023d000000016
Abstrakt:	Background: Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral 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 behavioral health EBPs in U.S. 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 COVID-19-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: Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize 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. Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest.
Databáze:	MEDLINE
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