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Table 6 Suggestions to enhance implementation efforts based on the RE-AIM framework

From: An implementation-focused process evaluation of an incentive intervention effectiveness trial in substance use disorders clinics at two Veterans Health Administration medical centers

Reach

• Target intervention to patients that will be attending treatment at least twice per week for other treatment services.

Effectiveness

• Share results of VA and non-VA trials

Adoption

• Solicit explicit support from the highest levels of the organization through, for example, performance measures or treatment recommendations.

• Identify or create measures of clinic effectiveness which can be utilized to identify gaps in performance and monitor the impact of implementation.

• Solicit agreement in advance for designated funding.

• Educate leadership about time commitment related to the intervention and potential strategies for integrating the intervention into current practices.

• Adopt incrementally. Start with a specific treatment track or clinic to reduce staff and funding burden until local evidence of effectiveness and feasibility is available to support spread

Implementation

• Disseminate information to educate staff about the process, goals, and value/effectiveness of the intervention and engage them in planning for the intervention from the start.

• Provide expert consultation on how to adapt the intervention for specific clinic environments.

• Train staff on urine test cups and breathalyzer including sensitivity and specificity of the screen results.

• Make scripts available for communicating positive and negative test results to patients.

• Supply a tracking database to ensure consistency in awarding prize picks.

• Provide a step by step intervention appointment protocol.

• Facilitate documentation in the electronic health record.

Maintenance

• Ensure all staff is aware of their responsibilities related to incorporating information from the intervention into clinical interactions with patients to facilitate integration into the clinic.

 

• Consider option of having case managers administer the intervention to their own patients rather than having one or two individuals responsible for the intervention.