Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in...

Area of Science:

• Healthcare Implementation Science
• Primary Care Medicine
• Systems Engineering in Healthcare

Background:

• Adoption of evidence-based practices (EBP) in healthcare is slow.
• This research pilots a novel 'systems consultation' strategy to expedite EBP adoption in primary care.
• The strategy, based on systems engineering principles, has been validated in addiction treatment settings.

Purpose of the Study:

• To pilot test the systems consultation strategy for improving opioid prescribing practices in primary care.
• To assess the feasibility, acceptability, and preliminary effectiveness of this innovative implementation approach.
• To lay the groundwork for a larger randomized clinical trial comparing systems consultation to other implementation strategies.

Main Methods:

• A matched-pairs design comparing four intervention clinics with four control clinics.
• Development of a checklist-based implementation guide from a leading opioid prescribing guideline.
• Use of physician peer coaches ('systems consultants') providing direct support to intervention clinics.
• Mixed-methods evaluation adhering to the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance).

Main Results:

• Pilot test results on feasibility, acceptability, and preliminary effectiveness are pending.
• The study is designed to provide data for a future large-scale randomized clinical trial.
• The primary unit of analysis is the clinic.

Conclusions:

• The systems consultation strategy shows potential for generalizing to the adoption of various clinical guidelines.
• This approach may significantly reduce the time lag in implementing evidence-based practices.
• Further research via a large randomized clinical trial is planned to compare systems consultation with strategies like audit/feedback and academic detailing.