Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites.
Identifying unique barriers to implementing rural emergency department-based peer services for opioid use disorder through qualitative comparison with urban sites.
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DOI：
10.1186/s13722-022-00324-3
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发表时间：
2022-07-28
影响因子：
3.7
通讯作者：
Gastala, Nicole
中科院分区：
文献类型：
--
作者：
Watson, Dennis P.;Staton, Monte D.;Gastala, Nicole
关键词：
为了解决目前的阿片类药物流行病，美国各地的一些医院已经实施了基于急诊科的干预措施，以吸引患有阿片类药物使用障碍的患者。目前的研究旨在解决知识的差距，在农村地区实施的一个子类型的这种干预措施，紧急部门为基础的同伴支持服务，通过比较实施农村和城市的方案，参加了印第安纳州的恢复教练和同伴支持倡议（RCPSI）。我们进行了二次分析的定性半结构化实施访谈收集的一部分，10个方案（4个农村和6个城市）参加RCPSI的评估。我们在实施的第一年的3个时间点对每个项目的代表进行了采访。我们的演绎编码过程是由实施研究的统一框架（CFIR）和外部上下文分类法指导的。我们确定了编码方案中5个主要结构对应的农村项目的关键差异。(1)干预特点：农村地区对干预措施是否适合其环境提出质疑，需要进行更多的调整，并遇到了意想不到的成本。(2)外部背景：农村医疗点没有适当的人员配备来满足病人的需要，在病人隐私方面遇到后勤和法律的障碍，病人的运输选择有限。(3)内部环境：农村地区缺乏强有力的内部沟通机制，难以与现有的文化和气候相结合。(4)个人特点：由于先前存在的态度和信念，一些农村提供者拒绝与同龄人合作。(5)实施过程：农村地点花了更多的时间来确定外部伙伴，放弃了最初实施计划的更多组成部分。研究结果表明，农村计划面临更大的挑战，随着时间的推移，实施紧急部门为基础的同行服务。这些挑战要求对最初计划进行灵活调整。考虑到我们的分析所确定的当地环境限制，农村项目可能需要灵活性来适应在城市环境中开发的干预措施，以确保成功。
In an effort to address the current opioid epidemic, a number of hospitals across the United States have implemented emergency department-based interventions for engaging patients presenting with opioid use disorder. The current study seeks to address gaps in knowledge regarding implementation of a sub-type of such interventions, emergency department-based peer support services, in rural areas by comparing implementation of rural and urban programs that participated in Indiana’s Recovery Coach and Peer Support Initiative (RCPSI). We conducted a secondary analysis of qualitative semi-structured implementation interviews collected as part of an evaluation of 10 programs (4 rural and 6 urban) participating in the RCPSI. We conducted interviews with representatives from each program at 3 time points over the course of the first year of implementation. Our deductive coding process was guided by the Consolidated Framework for Implementation Research (CFIR) and an external context taxonomy. We identified key differences for rural programs corresponding to each of the 5 primary constructs in the coding scheme. (1) Intervention characteristics: rural sites questioned intervention fit with their context, required more adaptations, and encountered unexpected costs. (2) External context: rural sites were not appropriately staffed to meet patient needs, encountered logistical and legal barriers regarding patient privacy, and had limited patient transportation options. (3) Inner setting: rural sites lacked strong mechanisms for internal communication and difficulties integrating with pre-existing culture and climate. (4) Characteristics of individuals: some rural providers resisted working with peers due to pre-existing attitudes and beliefs. (5) Implementation process: rural sites spent more time identifying external partners and abandoned more components of their initial implementation plans. Findings demonstrate how rural programs faced greater challenges implementing emergency department-based peer services over time. These challenges required flexible adaptations to originally intended plans. Rural programs likely require flexibility to adapt interventions that were developed in urban settings to ensure success considering local contextual constraints that were identified by our analysis.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2
作者：
Lancaster KE;Cooper HLF;Browning CR;Malvestutto CD;Bridges JFP;Young AM
通讯作者：
Young AM
影响因子：
5.1
作者：
Harder VS;Villanti AC;Heil SH;Smith ML;Gaalema DE;Meyer MC;Schafrick NH;Sigmon SC
通讯作者：
Sigmon SC
在南部农村州实施由急诊部门启动的丁丙诺啡治疗阿片类药物使用障碍。
影响因子：
3.9
作者：
Bogan C;Jennings L;Haynes L;Barth K;Moreland A;Oros M;Goldsby S;Lane S;Funcell C;Brady K
通讯作者：
Brady K
影响因子：
4.4
作者：
Meyerson, Beth E.;Lawrence, Carrie A.;Shannon, D. J.
通讯作者：
Shannon, D. J.