Table 4 Implementation strategies designed to address commonly identified CFIR barriers

Intervention characteristics: complexity

 Complexity of steps to diagnose AUD and select appropriate AUD medication prior to prescribing

One page “cheat sheet” of AUD diagnostic criteria

One page “cheat sheet” of FDA approved AUD medications

 Fears about managing withdrawal symptoms

One page “cheat sheet” for identifying risk for severe withdrawal with recommendations to refer to substance use disorder specialty care if present

Local clinical experts available for real-time consultation

*All brief resources connected to more extensive follow-up materials that providers could access if interested

Inner setting: compatibility

 20 min appointments every 6 months allow insufficient time for diagnosis and monitoring

Worked with each site to identify procedures to connect with Primary Care/Mental Health Integration staff to assist with AUD diagnosis and providing regular follow-up

Characteristics of individuals: knowledge and beliefs about the intervention

 Lack of training and knowledge about substance use disorder in general and AUD diagnosis and pharmacotherapy specifically

Training provided through multiple educational sessions in large groups and small team meetings as well as available on the project web-site

 Negative attitudes toward using medication to address substance use disorder

Frame pharmacotherapy as one option in treatment toolkit

Provided multiple resources for multiple treatment options to allow patient choice

Describe pharmacotherapy as possible “foot-in-the-door” for patients reluctant to engage in psychosocial treatments

Attitudes toward patients

 Generalize all AUD patients as unmotivated, highly complex, dishonest, etc.

Education provided on spectrum of AUD disorder and promote referral to specialty care for most severe and complex cases