McGuire Alan B, Salyers Michelle P, White Dominique A, Gilbride Daniel J, White Laura M, Kean Jacob, Kukla Marina
Health Services Research and Development, Richard L. Roudebush, Veterans Affairs Medical Center.
Department of Psychology, Indiana University Purdue University--Indianapolis.
Psychiatr Rehabil J. 2015 Dec;38(4):300-5. doi: 10.1037/prj0000116. Epub 2015 Apr 6.
Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation.
Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion.
Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time.
IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation.
疾病管理与康复（IMR）是一种循证实践，可帮助患者管理自身疾病并追求个人康复目标。尽管已有研究探讨了多方面积极推广所促进的IMR实施的影响因素，但本研究试图阐明在非研究驱动实施背景下影响IMR实施的因素。
在23家退伍军人事务部医疗中心对20名当地康复协调员和18名当地IMR专家进行了半结构化访谈。访谈调查了IMR实施中感知到的和实际遇到的障碍及促进因素。通过主题归纳/演绎分析（以结晶/沉浸的形式）对数据进行了分析。
实施IMR的地点与未提供IMR的地点在六个因素上存在差异：对IMR的认知、进口倡导者、支持自主性的领导、以退伍军人为中心的护理、敏感期的存在以及心理社会康复与恢复中心的存在。两组中共有四个因素：康复导向、循证实践导向、IMR在项目结构中的适配度感知以及工作人员时间的可用性。
可以采用IMR来替代积极的实施支持；然而，知识传播似乎是关键。未来的研究应探讨影响实施质量的因素。
