Planas Lourdes G
Department of Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, 1110 North Stonewall Avenue, Oklahoma City, OK 73117, USA.
Am J Health Syst Pharm. 2008 Oct 1;65(19):1854-63. doi: 10.2146/ajhp070366.
Strategies to improve the design, implementation, and evaluation of interventions in pharmacy practice-based research are discussed.
Various issues inherent in the clinical research continuum explain the lack of research translation into practice settings. The RE-AIM model is used to frame descriptions of strategies to design, implement, and evaluate practice-based research interventions. A major feature of RE-AIM is the shift in focus from short-term efficacy among restricted samples in controlled settings to longer-term effectiveness among more diverse samples in practice settings. The RE-AIM model consists of five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Various strategies are suggested to optimize an intervention's reach. In addition to clinical measures, economic, humanistic, and process measures are recommended for measuring and optimizing the effectiveness of an intervention. Adoption is considered an assessment of an intervention's reach at the organizational level. Assessment of representativeness among participating settings should also be conducted based on key characteristics relevant to a study. Several strategies are suggested to improve stakeholder buy in, thereby increasing the likelihood of intervention adoption. Intervention fidelity is important for maximizing a study's internal validity and consists of two components: integrity and differentiation. Several factors influence the likelihood and degree of intervention maintenance, including the use of existing personnel to deliver an intervention and evaluation measures that are meaningful to institutional stakeholders.
Application of the RE-AIM model's dimensions can enhance the reach, effectiveness, adoption, implementation, and maintenance of interventions, thus improving the quality and impact of practice-based research.
讨论改善基于药学实践研究的干预措施设计、实施和评估的策略。
临床研究连续过程中存在的各种问题解释了为何研究成果难以转化到实践环境中。RE-AIM模型用于构建设计、实施和评估基于实践的研究干预措施的策略描述。RE-AIM的一个主要特点是关注点从受控环境中受限样本的短期疗效转变为实践环境中更多样化样本的长期效果。RE-AIM模型由五个维度组成：覆盖范围、有效性、采用率、实施情况和维持情况。建议采用各种策略来优化干预措施的覆盖范围。除了临床指标外，还推荐使用经济、人文和过程指标来衡量和优化干预措施的有效性。采用率被视为在组织层面评估干预措施的覆盖范围。还应根据与研究相关的关键特征对参与环境的代表性进行评估。建议采用多种策略来提高利益相关者参与度，从而增加干预措施被采用的可能性。干预保真度对于最大化研究的内部效度很重要，它由两个部分组成：完整性和差异性。有几个因素会影响干预措施维持的可能性和程度，包括利用现有人员实施干预措施以及采用对机构利益相关者有意义的评估措施。
应用RE-AIM模型的维度可以提高干预措施的覆盖范围、有效性、采用率、实施情况和维持情况，从而提高基于实践研究的质量和影响力。
