O'Grady Megan A, Lincourt Patricia, Hong Sueun, Hussain Shazia, Neighbors Charles J
University of Connecticut School of Medicine, Department of Public Health Sciences, 263 Farmington Ave., Farmington, CT 06030-6325, United States.
NYS Office of Addiction Services and Supports, 1450 Western Ave., Albany, NY 12203, United States.
J Subst Use Addict Treat. 2025 Feb;169:209605. doi: 10.1016/j.josat.2024.209605. Epub 2024 Dec 12.
Measurement-based care (MBC), routinely measuring and reviewing treatment progress with a standardized tool, can inform clinical decision making and improve patient outcomes. Despite potential benefits, implementation of MBC in SUD treatment settings has been limited and little is known about its implementation in SUD settings. The goal of this convergent parallel mixed methods study was to understand staff experiences during early implementation of MBC in SUD treatment clinics.
The Treatment Progress Assessment-8 (TPA8) is an 8-item measure that supports MBC with an electronic system (eTPA8) allowing client completion on electronic devices and providing staff reports. The study introduced the eTPA8 into 13 clinics using external practice facilitation and implementation teams. Quantitative data examining implementation included eTPA8 system data (1672 administrations) and staff surveys (n = 70) using feasibility, acceptability, and appropriateness measures. Semi-structured interviews (n = 34) were conducted with clinic staff. To analyze data, we classified clinics into adopters, non-adopters, and sustainers using eTPA8 system data. One-way ANOVA compared these classifications on the three implementation outcome measures. Rapid qualitative analysis was used for the interviews.
There were significant differences between staff in sustainer (M = 3.90) and non-adopter (M = 3.21) clinics on the feasibility measure (F(2, 68) = [4.28], p = 0.018). SUD program staff found the eTPA8 to be user-friendly, appropriate, and acceptable. There was some variation in perceived feasibility of regular use of the eTPA8, especially given competing demands and time constraints. Staff found the eTPA8 useful to support clinical interactions but varied in embracing new technology and the overall MBC concept. The inner and outer contexts influenced implementation and required attention by clinic champions and implementation teams. External practice facilitators were key to addressing barriers in an ongoing and flexible manner.
Implementing MBC using the eTPA8 showed promise. Staff felt the TPA8 was generally clinically useful, appropriate, and acceptable; yet feasibility was variable. Adoption of MBC faced barriers (e.g., competing demands). Implementation required relatively intensive implementation supports that were dynamic, proactive, and responsive. Findings have implications for guiding development and refinement of responsive, theory-driven implementation strategies to support MBC in SUD treatment settings, with a particular focus on addressing feasibility.
基于测量的照护（MBC），即使用标准化工具定期测量和评估治疗进展，可为临床决策提供依据并改善患者治疗效果。尽管有潜在益处，但MBC在物质使用障碍（SUD）治疗环境中的实施有限，且对其在SUD环境中的实施情况知之甚少。这项收敛平行混合方法研究的目的是了解在SUD治疗诊所早期实施MBC期间工作人员的经历。
治疗进展评估-8（TPA8）是一项包含8个条目的测量工具，通过电子系统（eTPA8）支持MBC，允许患者在电子设备上完成填写并为工作人员提供报告。该研究通过外部实践促进和实施团队将eTPA8引入13家诊所。检查实施情况的定量数据包括eTPA8系统数据（1672次管理记录）和工作人员调查（n = 70），采用可行性、可接受性和适宜性测量方法。对诊所工作人员进行了半结构化访谈（n = 34）。为了分析数据，我们使用eTPA8系统数据将诊所分为采用者、非采用者和维持者三类。单因素方差分析比较了这三类在三种实施结果测量指标上的差异。对访谈采用快速定性分析。
在可行性测量指标上，维持者诊所（M = 3.90）和非采用者诊所（M = 3.21）的工作人员之间存在显著差异（F(2, 68) = [4.28]，p = 0.018）。SUD项目工作人员认为eTPA8易于使用、适宜且可接受。对于定期使用eTPA8的感知可行性存在一些差异，特别是考虑到相互竞争的需求和时间限制。工作人员发现eTPA8有助于支持临床互动，但在接受新技术和整体MBC概念方面存在差异。内部和外部环境影响实施情况，需要诊所倡导者和实施团队予以关注。外部实践促进者是以持续且灵活的方式解决障碍的关键。
使用eTPA8实施MBC显示出前景。工作人员认为TPA8总体上在临床上有用、适宜且可接受；然而可行性存在差异。采用MBC面临障碍（例如相互竞争的需求）。实施需要相对密集的实施支持，这些支持应是动态、积极主动且具有响应性的。研究结果对于指导制定和完善响应性、理论驱动的实施策略以支持SUD治疗环境中的MBC具有启示意义，尤其侧重于解决可行性问题。
