Jakubowski Andrea, Patrick Briana, DiClemente-Bosco Kira, Salino Sarah, Scott Kelli, Becker Sara
Montefiore Medical Center.
Stanford University School of Medicine.
Res Sq. 2024 Oct 21:rs.3.rs-4912858. doi: 10.21203/rs.3.rs-4912858/v1.
Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation.
Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation.
Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts.
The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.
应急管理（CM）是治疗兴奋剂使用障碍最有效的方法，但尽管在阿片类药物治疗项目（OTP）中兴奋剂使用很普遍，但该方法在这些项目中的应用却未得到充分利用。作为一项全州范围倡议的一部分，我们试点了一项新的评估，即影响成功实施与维持的因素清单（IFASIS），以研究在一系列OTP中实施数字CM平台的决定因素。我们描述了IFASIS如何用于阐明可推广的和特定情境的实施决定因素，并指导实施促进工作。
六个OTP接受了多层次的实施策略（包括促进措施），以推动数字CM平台在项目中的采用。在实施前，OTP完成了IFASIS，这是一份包含27个条目的问卷，评估四个领域中决定因素的效价（积极/消极）和重要性：组织外部、组织内部、关于干预措施以及关于干预接受者。OTP工作人员以团队形式完成IFASIS，在记录的讨论中确定共识评级。使用快速定性分析方法对IFASIS记录的文字记录进行分析。将IFASIS的定量结果汇总为各组织内部和之间的中位数及范围。对实施促进会议记录进行分析，以研究IFASIS如何用于指导促进工作。
定量评级和定性反馈揭示了数字CM平台实施的常见障碍，包括缺乏可持续的资金来源、缺乏外部和组织政策、高层领导支持不足以及工作人员对CM的态度不一。常见的实施促进因素包括组织领导层的热情和承诺，以及认为数字CM平台将减轻OTP咨询师的工作量和负担。IFASIS通过多种方式用于指导促进工作，包括激发关于障碍和促进因素的讨论、集思广益解决被评为“非常重要”的障碍的策略，以及确定可作为实施工作一部分加以利用的促进因素。
IFASIS确定了OTP中CM实施的重要决定因素，并在塑造促进措施方面发挥了作用。IFASIS可能是实施科学领域用于识别和解决可推广的和特定情境的实施决定因素的一项有价值的评估工具。
