Commentary on “The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample.”

Commentary: The recent article in Implementation Science by Rogal and colleagues touches on two timely and critical issues related to dissemination and implementation research. The first is the importance of utilizing evidence-based implementation strategies to move effective programs, practices, treatments, and policies into everyday use. The second important concept is providing quantitative empirical evidence to determine whether the implementation strategies utilized are associated with the increased uptake of evidence-based practices (EBP). Based on work from the Expert Recommendations for Implementing Change (ERIC) study to refine and develop distinct implementation strategies and categories of implementation strategies, Rogal and colleagues tested whether the 73 discrete implementation strategies organized into 9 categories were associated with the uptake of EBP to treat Hepatitis C in the Veterans Health Administration. Interestingly the authors found that the total number of strategies endorsed was positively correlated with the number of treatment starts, but, only three of the top 15 most frequently used strategies, however, were associated with use of the EBP.

As noted by the authors, this study not only provides valuable empirical evidence confirming the proposed positive relationship between the number of implementation strategies used and greater uptake of EBP, but it also provides an initial step in identifying which strategies are associated with the uptake of EBP.  Also of importance, the study provides initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale.

The results also, however, highlight the disconnect between what the most frequently used implementation strategies were and what was associated with the use of the EBP. The strategies may be what practitioners think are the critical implementation strategies to promote use of the EBP or they may be more of a function of what resources are available at the organization. The authors suggest they may also be intertwined with the complexity of the implementing organization. Regardless, practitioners not only need evidence regarding therapy or program selection, but they also need evidence regarding specific successful implementing strategies. As the field of implementation research continues to grow and we gather more data regarding what works in specific contexts and in what ways, we will be able to provide more empirical evidence to promote the dissemination of EBP coupled with evidence-based implementation strategies.

Read the abstract.