Ensuring intervention success: Assessing fit as an overlooked step of the implementation process

Blanchard, Carrie; Livet, Melanie

doi:10.18549/pharmpract.2020.4.2235

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…Barriers with adoption and implementation, such as lack of contextual fit, insufficient training, competing demands, and complexity of interventions themselves ,may undermine successful implementation and result in inadequate treatment fidelity. Successful implementation of any intervention will be dependent on the ability to integrate it within the context of a specific health care system and setting 42 . Thus, institutions aspiring to reduce postpartum inpatient opioid use or opioid prescribing should consider implementing the intervention that is most suited for their setting.…”

Section: Discussionmentioning

confidence: 99%

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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Introduction As deaths related to opioids continue to rise, reducing opioid use for postpartum pain management is an important priority. Thus, we conducted a systematic review of postpartum interventions aimed at reducing opioid use following birth. Methods From database inception through September 1, 2021, we conducted a systematic search in Embase, MEDLINE, Cochrane Library, and Scopus including the following Medical Subject Heading (MeSH) terms: postpartum, pain management, opioid prescribing. Studies published in English, restricted to the United States, and evaluating interventions initiated following birth with outcomes including an assessment of change in opioid prescribing or use during the postpartum period (<8 weeks postpartum) were included. Authors independently screened abstracts and full articles for inclusion, extracted data, and assessed study quality using the Grading of Recommendations, Assessment, Development, and Evaluation tool and risk of bias using the Institutes of Health Quality Assessment Tools. Results A total of 24 studies met inclusion criteria. Sixteen studies evaluated interventions aimed at reducing postpartum opioid use during the inpatient hospitalization, and 10 studies evaluated interventions aimed at reducing opioid prescribing at postpartum discharge. Inpatient interventions included changes to standard order sets and protocols for the management of pain after cesarean birth. Such interventions resulted in significant decreases in inpatient postpartum opioid use in all but one study. Additional inpatient interventions, including use of lidocaine patches, postoperative abdominal binder, valdecoxib, and acupuncture were not found to be effective in reducing postpartum opioid use during inpatient hospitalization. Interventions targeting the postpartum period included individualized prescribing and state legislative changes limiting the duration of opioid prescribing for acute pain both resulted in decreased opioid prescribing or opioid use. Discussion A variety of interventions aimed at reducing opioid use following birth have shown efficacy. Although it is not known if any single intervention is most effective, these data suggest that implementation of any number of interventions may be advantageous in reducing postpartum opioid use.

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Section: Discussionmentioning

confidence: 99%

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Badreldin

DiTosto

Holder

et al. 2023

J Midwife Womens Health

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“…Although current literature recognizes the need to align service selection with the implementing context, 28–30 few frameworks acknowledge fit as a pre‐implementation facilitator that is conceptually different from implementation readiness 31 . Defining fit more specifically through newly created assessment and tools would lead to the identification of the most appropriate specialty contexts for CMM 32 …”

Section: Discussionmentioning

confidence: 99%

“…31 Defining fit more specifically through newly created assessment and tools would lead to the identification of the most appropriate specialty contexts for CMM. 32 While this study generated a preliminary understanding of the viability of CMM in specialty clinics, it has a number of limitations.…”

Section: Discussionmentioning

confidence: 99%

Integrating comprehensive medication management in specialty clinics: A feasibility study

Livet

Richard

Pathak

et al. 2023

J Am Coll Clin Pharm

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Introduction: Patients dealing with complex medical conditions requiring specialty care and polypharmacy therapy experience many challenges, including the lack of adequate medication optimization services. Pharmacists within specialty clinics are uniquely positioned to improve patient care by offering comprehensive medication management (CMM) services.Objectives: This study explores the feasibility of CMM delivery by clinical pharmacists within specialty clinics. More specifically, it aimed to (1) assess the pharmacists, pharmacy managers, and clinic team members' experience with CMM implementation; and (2) evaluate preliminary evidence of treatment effectiveness.Methods: Seven specialty clinics within an academic medical center were recruited to prepare for, implement, and evaluate CMM over an 18-month period, with two additional clinics joining mid-project. This exploratory feasibility study used mixed data to understand levels of service adoption, evaluate changes in feasibility indicators (acceptability, appropriateness, practicality, intent to continue use, and satisfaction), collect implementation feasibility insights, and evaluate treatment outcomes, both perceived and based on medication therapy problem (MTP) resolution rates. Data sources included administrative data, surveys, interviews, and MTP documentation.Results: Service uptake was highly context dependent, with three of the five clinics discontinuing participation doing so because of challenges with service fit (appropriateness). For the four clinics implementing CMM throughout the study, the benefits were evidenced by the positive changes in the feasibility indicators ratings, perceived improved patient care, and a 96.2% MTP resolution rate. Gaining an understanding of CMM as a service and its potential role within a specialty clinic, ensuring buy-in from clinics and management, identifying implementation strategies such as preparation of workflows, and using a standardized MTP documentation form were highlighted as critical to successful implementation. Conclusion:Providing CMM as a service option for complex patients in specialty care clinics was deemed feasible and beneficial, providing alignment with the clinic culture, patient care approach, and pharmacist role.

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“…Another example of a deep-structure adaptation might involve review and refinement of intervention structures. While maintaining structure and program integrity is a central and worthy goal, it must be balanced with cultural norms to ensure program fit or appropriateness, increasing the likelihood of content uptake and application by participants (Blanchard & Livet, 2020;Proctor et al, 2011). Creating opportunity for families and parent coaches to incorporate the unique cultural norms and traditions of participating families is one example of a deep-structure adaptation that could enhance cultural responsivity.…”

Section: Discussionmentioning

confidence: 99%

Lost in Translation: Bilingual Parent Coaches' Experiences Implementing an Un-adapted Early Childhood Intervention with Non-English Speakers

Sattler

Paceley

Byers

et al. 2022

Glob Implement Res Appl

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When implementing an evidence-based intervention in new contexts and with different populations, evaluation of not only outcomes, but also implementation processes become necessary. The purpose of this study was to explore the experiences of bilingual, bicultural parent coaches delivering Attachment and Biobehavioral Catch-up (ABC), an early childhood evidence-based home visiting intervention (EBI), to Spanish-speaking families in the United States (U.S.). This qualitative study draws on semi-structured interviews completed with four ABC parent coaches in two U.S. states. All participants identify as female and are bicultural, native Spanish speakers. Analyses resulted in six themes organized into two broad categories: (1) challenges to providing ABC to Spanish-speaking families and (2) positive experiences providing ABC to Spanish-speaking families. Results highlight that in-the-field translation and delivery of an empirically supported early intervention that has not been adapted for use with non-English speakers is challenging even for bilingual, bicultural parent coaches. Opportunities for deep-structure adaptations of the ABC intervention are explored. Practice and research implications also are discussed.

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Ensuring intervention success: Assessing fit as an overlooked step of the implementation process

Cited by 11 publications

References 22 publications

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

Integrating comprehensive medication management in specialty clinics: A feasibility study

Lost in Translation: Bilingual Parent Coaches' Experiences Implementing an Un-adapted Early Childhood Intervention with Non-English Speakers

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