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Table 4 Implementation strategies designed to address commonly identified CFIR barriers

From: Implementing alcohol use disorder pharmacotherapy in primary care settings: a qualitative analysis of provider-identified barriers and impact on implementation outcomes

CFIR construct and barrier summary Implementation strategies to address identified 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