Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia.
Implement Sci. 2021 Mar 4;16(1):22. doi: 10.1186/s13012-021-01090-7.
There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR).
A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020).
Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation.
While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks.
目前，在改善药物和酒精环境中基于证据的护理实施方面，缺乏转化研究计划。本系统评价旨在使用实施研究综合框架（CFIR），综合评估和评价治疗药物和酒精问题患者的治疗实施计划的有效性。
使用五个在线数据库（从创建开始）进行全面的系统评价。合格的研究包括评估用于实施基于证据的心理社会治疗酒精和物质使用障碍的策略的临床试验和观察性研究。根据 CFIR，提取的数据进行了定性综合，以获得共同主题。主要结果包括实施、服务系统或临床实践。使用适当的工具评估个别研究的偏倚风险。该方案已在（PROSPERO）（CRD42019123812）上注册，并已预先发表（Louie 等人，系统 9:2020）。
在 2965 条参考文献中，有 20 项研究纳入本综述。实施研究采用了广泛的策略来培训临床医生掌握一些关键的治疗方法。实施策略的信息来源于一系列理论，只有两项研究使用实施框架（Baer 等人，J 物质滥用治疗 37:191-202，2009）使用情境定制培训和 Helseth 等人，J 物质滥用治疗 95:26-34，2018）使用 CFIR）。纳入研究评估了 CFIR 的 36 个子域中的 30 个子域，但大多数涉及个人特征域（75%），干预特征域（45%）和内部环境结构域（25%）的评估较少，只有一项研究测量外部环境和过程域。最常见的主要结果是实施策略对治疗一致性的有效性。尽管一些研究发现临床医生的特征会影响实施结果（40%），并且许多研究获得了临床结果（40%），但只有五项研究测量了服务系统结果，只有四项研究评估了实施情况。
虽然在个人特征和干预特征（例如教育、信念和态度以及组织对新技术的开放性）等领域的研究已经开始积累，但本综述确定了 CFIR 其他领域的重大差距，包括组织因素、外部力量以及与实施过程本身相关的因素。审查结果突出了未来研究的重要领域和应用综合实施框架的实用性。
