A systematic review of evidence-based practice implementation in drug and alcohol settings: applying the consolidated framework for implementation research framework

Abstract

Background 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). Methods 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). Results 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. Conclusions 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.

Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings

“…This is an important distinction, since findings from the field of implementation science consistently demonstrate that the implementation process itself also has implications for implementation outcomes (9,10). A recent systematic review of evidence-based practise implementation in AOD settings found that only two of the twenty included studies employed a comprehensive implementation framework, and no included studies focused on treating comorbidity (11).…”

“…It includes five domains of influence derived from a consolidation of the plethora of terms and concepts generated by implementation researchers: (1) intervention characteristics (e.g., evidence strength and quality, adaptability), (2) outer setting (e.g., patient needs and resources, external policies and incentives), (3) inner setting (e.g., implementation climate, readiness for implementation), (4) individuals involved (e.g., self-efficacy, knowledge, and beliefs about the intervention), and (5) the implementation process (e.g., engaging members of the organisation, executing the innovation). No previous studies have systematically evaluated barriers and facilitators of implementation of comorbidity training according to a validated framework, which is key to refining ongoing training programs and future roll out efforts (11).…”

Editorial

“…This could add to the quality of publications in many ways: "using adequate research frameworks and models helps research studies to frame study questions and hypotheses, link to important background literature, clarify constructs to be measured, depict relationships to be tested and contextualize results, they provide a common language and thus allow to advance and develop cumulative evidence" (Birken et al, 2017). A recent systematic review has proved the utility of applying comprehensive implementation frameworks in implementation research (Louie et al, 2021).…”

Relationship Between Clinician-Level Attributes and Implementation Outcomes From The Pathways To Comorbidity Care Training Program

“…From a theoretical perspective, social cognitive theories have been widely used to explain health-related behaviours of individuals [12]. Although very little research has applied social cognitive theories to the study of health practitioner behaviour [13], research evaluating EBP implementation in drug and alcohol settings has often been guided by the assumption that clinician factors have an important relationship to implementation delity [14]. Clinician factors most frequently measured in such studies include demographics (e.g.…”

“…Organisational change theories such as Rogers' [31] diffusion of innovations theory have also highlighted the importance of clinician perceptions of the capacity of their organisation to support and implement new innovations, and drug and alcohol clinician perceptions of factors related to their organisational context have been evaluated as a possible mediator of implementation delity [15]. While clinician demographics have frequently been included in studies investigating factors related to implementation delity in drug and alcohol contexts, signi cant relationships are not often found [14]. Some studies have indicated that higher levels of education are associated with higher delity [15], that this distinction is sometimes no longer present following training [25], and that clinicians with lower levels of education can demonstrate greater increases in implementation delity following training [16].…”