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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.