A mixed-methods study of staff perspectives on the barriers and facilitators to the implementation of patient-reported routine outcome measures and feedback in alcohol and other drug treatment

IntroductionPreliminary evidence supports the use of patient-reported outcome measures (PROM) and feedback for enhancing client outcomes in alcohol and other drug (AOD) treatment. However, successful implementation remains challenging. This mixed-methods study applied the Consolidated Framework for Implementation Research (CFIR) framework to examine inner setting and staff characteristics that act as barriers and facilitators to the implementation of PROMs in AOD treatment.MethodsTo understand CFIR-informed barriers and facilitators to implement PROMs in AOD treatment, qualitative interviews were conducted with N = 23 AOD counsellors. A separate quantitative survey was conducted with N = 108 AOD counsellors.ResultsFour qualitative themes emerged: (i) PROMs and feedback are valuable to AOD treatment; (ii) counsellor resistance towards PROMs and feedback is a barrier to successful implementation; (iii) competing interests and logistical issues are barriers to the implementation of PROMs and feedback; and (iv) PROMs are a burden to clients that may serve to disengage them from treatment. Survey results indicated a positive association between leadership support (CFIR inner setting construct) and counsellor knowledge and beliefs regarding PROMs and feedback (CFIR staff characteristics construct; beta = 0.35, 95% CI [0.13, 0.60]). Findings demonstrated a positive association between available PROMs resources (CFIR inner setting construct) and both knowledge and beliefs regarding PROMs and feedback (beta = 0.31, 95% CI [0.14, 0.48]) and self-efficacy to implement PROMs and feedback (CFIR staff characteristics construct; beta = 0.18, 95% CI [0.04, 0.32]).Discussion and ConclusionsFindings point to the critical need to adopt a whole-of-organisation approach to foster buy-in for PROMs and feedback to support successful implementation.