Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care.
Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care.
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DOI：
10.1186/s13722-023-00429-3
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发表时间：
2024-01-10
影响因子：
3.7
通讯作者：
Williams, Emily C.
中科院分区：
文献类型：
--
作者：
Soyer, Elena M.;Frost, Madeline C.;Fletcher, Olivia V.;Ioannou, George N.;Tsui, Judith I.;Edelman, E. Jennifer;Weiner, Bryan J.;Bachrach, Rachel L.;Chen, Jessica A.;Williams, Emily C.
关键词：
不健康饮酒 (UAU) 对于患有慢性肝病的人来说尤其危险。肝脏诊所可能是通过整合循证策略（例如针对酒精使用障碍的简短干预和药物治疗）来提供有效的酒精相关护理的重要场所。我们对四个退伍军人健康管理局 (VA) 医疗中心的肝脏诊所的临床利益相关者和患者进行了定性访谈，以了解整合酒精相关护理的障碍和促进因素，并支持定制实践促进实施干预措施。数据收集和分析以实施研究综合框架（CFIR）为指导。使用 CFIR 指导下的快速评估流程 (RAP) 对访谈进行转录和定性分析。我们采访了 46 名临床利益相关者和 41 名患者参与者，并根据 CFIR 分析了结果。临床利益相关者描述了障碍和促进因素，范围从基于运营/诊所资源的（例如，时间和能力、对其他提供者类型的渴望、转诊流程）到基于个人观点和偏好的（例如，领导的支持、个人经验/信仰）。患者参与者分享了障碍和促进因素，范围从基于关系的（例如，信任提供者和感觉受到评判）到基于资源和教育的（例如，与一系列治疗方案的联系、有关酒精影响的教育）。 在肝脏诊所整合酒精相关护理的许多障碍和促进因素与其他临床环境中发现的障碍和促进因素相似（例如时间、资源、角色明确性、污名化信念）。然而，一些障碍（例如，同伴主导的护理以及肝脏诊所与成瘾专家缺乏整合）和促进因素（例如，诊所中存在质量改进人员以及综合药剂师和行为健康专家）对于肝脏诊所来说更为独特。这些发现支持将酒精相关护理纳入肝脏诊所的可能性，但强调了调整工作以考虑提供者信念、经验和诊所资源差异的重要性。这些访谈中确定的障碍和促进因素被用来在每个诊所环境中制定实践促进实施干预措施。在线版本包含可在 10.1186/s13722-023-00429-3 获取的补充材料。
Unhealthy alcohol use (UAU) is particularly dangerous for people with chronic liver disease. Liver clinics may be an important setting in which to provide effective alcohol-related care by integrating evidence-based strategies, such as brief intervention and medications for alcohol use disorder. We conducted qualitative interviews with clinical stakeholders and patients at liver clinics in four Veterans Health Administration (VA) medical centers to understand barriers and facilitators of integrating alcohol-related care and to support tailoring of a practice facilitation implementation intervention. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process (RAP) guided by the CFIR. We interviewed 46 clinical stakeholders and 41 patient participants and analyzed findings based on the CFIR. Clinical stakeholders described barriers and facilitators that ranged from operations/clinic resource-based (e.g., time and capacity, desire for additional provider types, referral processes) to individual perspective and preference-based (e.g., supportiveness of leadership, individual experiences/beliefs). Patient participants shared barriers and facilitators that ranged from relationship-based (e.g., trusting the provider and feeling judged) to resource and education-based (e.g., connection to a range of treatment options, education about impact of alcohol). Many barriers and facilitators to integrating alcohol-related care in liver clinics were similar to those identified in other clinical settings (e.g., time, resources, role clarity, stigmatizing beliefs). However, some barriers (e.g., fellow-led care and lack of integration of liver clinics with addictions specialists) and facilitators (e.g., presence of quality improvement staff in clinics and integrated pharmacists and behavioral health specialists) were more unique to liver clinics. These findings support the possibility of integrating alcohol-related care into liver clinics but highlight the importance of tailoring efforts to account for variation in provider beliefs and experiences and clinic resources. The barriers and facilitators identified in these interviews were used to tailor a practice facilitation implementation intervention in each clinic setting. The online version contains supplementary material available at 10.1186/s13722-023-00429-3.
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影响因子：
7.2
作者：
Damschroder, Laura J.;Reardon, Caitlin M.;Widerquist, Marilla A. Opra;Lowery, Julie
通讯作者：
Lowery, Julie
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：
3.1
作者：
Patel, Yuval A.;Yao, Jia;Proeschold-Bell, Rae Jean;Niedzwiecki, Donna;Goacher, Elizabeth;Muir, Andrew J.
通讯作者：
Muir, Andrew J.
影响因子：
3.8
作者：
Harris, Alex H. S.;Oliva, Elizabeth;Trafton, Jodie A.
通讯作者：
Trafton, Jodie A.
影响因子：
5.5
作者：
Beste, Lauren A.;Ioannou, George N.
通讯作者：
Ioannou, George N.