■确定可行和有效的实施策略仍然是一个重大挑战。目前,预期纳入实施试验的战略数量之间存在差距,通常四个或更少,以及回顾性使用的策略数量,通常是20或更多。这一差距表明,需要更好地理解在实施科学和实践中应考虑的实施战略的范围。
■这项研究提出了专家建议,以确定在美国退伍军人事务部实施三项精神卫生保健高优先级实践(HPP)的73种离散实施策略中,哪些策略被认为是必不可少的:初级保健精神卫生中的抑郁结果监测(n=20)。长期暴露疗法治疗创伤后应激障碍(n=22),以及服用抗精神病药物的患者的代谢安全性监测(n=20)。参与者具有实施科学方面的专业知识,特定的HPP,或者两者兼而有之。使用高度结构化的推荐过程来获得每个HPP的推荐。
■大多数共识被确定为26个或更多的策略是绝对必要的;在三个HPP中,53个或更多的策略被确定为可能必要或绝对必要的。
■被确定为必不可少的大量策略与现有研究形成鲜明对比,现有研究主要侧重于应用单一策略来支持实施。需要对多战略实施举措进行系统的调查和记录。
■大多数实施研究侧重于相对较少数量的离散实施策略对实践的吸收的影响。然而,系统地调查提供者的研究发现,在实施计划的背景下,可以确定数十个或更多的离散实施策略。这项研究让实施科学和临床实践的专家参与了一个结构化的建议过程,以确定73个专家建议中的哪些实施变更(ERIC)实施策略被认为是绝对必要的。可能是必不可少的,可能无关紧要,对于三种不同的精神卫生保健实践中的每一种都是绝对不必要的:初级保健中的抑郁结果监测,创伤后应激障碍的长期暴露疗法,以及服用抗精神病药物的患者的代谢安全性监测。结果突出表明,专家们认为大量战略对于支持实施精神卫生保健实践是绝对或可能必不可少的。例如,26种策略被确定为对所有三种精神卫生保健实践绝对必要。在所有三种实践中,另外27种策略被确定为绝对或可能至关重要。这项研究指出,未来的研究需要记录一项举措所经历的决策过程,以确定在实施工作中应包括和排除哪些战略。特别是,本文档的结构化方法可能是必要的,以确定可能是护理环境内生的策略,并且可能不会被确定为“故意”用于支持实践或干预。
UNASSIGNED: Identifying feasible and effective implementation strategies remains a significant challenge. At present, there is a gap between the number of strategies prospectively included in implementation trials, typically four or fewer, and the number of strategies utilized retrospectively, often 20 or more. This gap points to the need for developing a better understanding of the range of implementation strategies that should be considered in implementation science and practice.
UNASSIGNED: This study elicited expert recommendations to identify which of 73 discrete implementation strategies were considered essential for implementing three mental health care high priority practices (HPPs) in the US Department of Veterans Affairs: depression outcome monitoring in primary care mental health (n = 20), prolonged exposure therapy for treating posttraumatic stress disorder (n = 22), and metabolic safety monitoring for patients taking
antipsychotic medications (n = 20). Participants had expertise in implementation science, the specific HPP, or both. A highly structured recommendation process was used to obtain recommendations for each HPP.
UNASSIGNED: Majority
consensus was identified for 26 or more strategies as absolutely essential; 53 or more strategies were identified as either likely essential or absolutely essential across the three HPPs.
UNASSIGNED: The large number of strategies identified as essential starkly contrasts with existing research that largely focuses on application of single strategies to support implementation. Systematic investigation and documentation of multi-strategy implementation initiatives is needed.
UNASSIGNED: Most implementation studies focus on the impact of a relatively small number of discrete implementation strategies on the uptake of a practice. However, studies that systematically survey providers find that dozens or more discrete implementation strategies can be identified in the context of the implementation initiative. This study engaged experts in implementation science and clinical practice in a structured recommendation process to identify which of the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies were considered absolutely essential, likely essential, likely inessential, and absolutely inessential for each of the three distinct mental health care practices: depression outcome monitoring in primary care, prolonged exposure therapy for posttraumatic stress disorder, and metabolic safety monitoring for patients taking
antipsychotic medications. The results highlight that experts consider a large number of strategies as absolutely or likely essential for supporting the implementation of mental health care practices. For example, 26 strategies were identified as absolutely essential for all three mental health care practices. Another 27 strategies were identified as either absolutely or likely essential across all three practices. This study points to the need for future studies to document the decision-making process an initiative undergoes to identify which strategies to include and exclude in an implementation effort. In particular, a structured approach to this documentation may be necessary to identify strategies that may be endogenous to a care setting and that may not be otherwise be identified as being \"deliberately\" used to support a practice or intervention.