From policy to practice: implementing frontline community health services for substance dependence-study protocol

Abstract

BackgroundSubstance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2).Methods/DesignPhase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health.DiscussionFindings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center

“…An alternative explanation may be that services for SUDs in primary are scarce in Quebec, as in most other countries, so these patients have to seek help in specialized care [ 86 , 87 ]. Some individuals attending the ARC could have been under the clinical threshold for a diagnosis of SUD, but nonetheless were experiencing important substance use problems [ 88 ]. Furthermore, a comparison between this research and previous studies is somewhat limited by methodological differences, for instance in terms of definitions of high service users, measured outcomes, and subpopulations.…”

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics

“…When available, case documentation such as organizational guidelines and strategic plans related to the Addictions Program was collected and integrated for a more thorough understanding of the process and level of implementation of primary care addiction services at each site. Additional details regarding the study protocol and methods are available in Gill et al (2014).…”

Impact of Ed-LinQ: A Public Policy Strategy to Facilitate Engagement between Schools and the Mental Health Care System in Queensland, Australia

“…So far, the quantitative studies focusing on the policy-to-practice impact of health interventions and strategies have been mainly limited to the impact on outcomes for the individual and population [20,[50][51][52][53]. A complementary measurement of the process of impact, including adoption by the target organisations and penetration in the target audience, is needed [25]; it is a necessary preliminary step in the evaluation of quality.…”

“…The conditions for assessing such impacts hugely depend on the intervention implemented, the target organisation, the policy environment, the social context, the time frame for impact assessment and whether the transfer from research to policy, from research to practice or from evidence-informed policy to practice is measured. If public policy interventions in the care sector can potentially provide key findings for decision making, the number of studies that have assessed the impact of such interventions and monitor care policy strategies to determine their impact on practice (policy-to-practice impact) is low [20,21]. In addition, there is a lack of agreement on the basic components that should be assessed in impact analysis, particularly in relation to the processes involved in the adoption by the end-users of any strategy or plan.…”