ror.org/04cpxjv19
Abstracts
Résumé
Objectif : Les intervenants de première ligne sont en position idéale pour fournir des services de repérage, détection, interventions brèves et orientation (RDIBO) aux patients ayant un problème de dépendance. Par contre, la mise en oeuvre du RDIBO dans la pratique clinique présente de nombreux défis et son adoption généralisée s’avère lente. L’objectif global de cette recherche a été d’examiner les expériences vécues par les intervenants de première ligne ayant suivi les ateliers de formation du ministère de la Santé et des Services sociaux (MSSS) afin de mettre en oeuvre le programme-services Dépendances et, ensuite, d’étudier la relation entre cette formation et l’intégration des savoirs acquis à la pratique.
Méthodes : Deux groupes de discussion focalisée ont eu lieu avec un total de 10 intervenants de première ligne et, dans une seconde phase, 69 questionnaires ont été distribués à d’autres intervenants, dont 22 avaient eu l’occasion de suivre la formation du MSSS. Tous les intervenants provenaient d’un centre de santé et de services sociaux (CSSS) qui était dans le processus de mise en place des services de première ligne en dépendance, tel qu’exigé par le programme-services Dépendances du MSSS.
Résultats : Bien que la formation ait contribué à accroître la connaissance des participants sur la dépendance, les participants ont dit faire peu usage des outils de formation et avoir apporté peu de changements concrets à leur pratique clinique postatelier. En outre, les participants ont eu le sentiment que la formation dispensée ne les a pas suffisamment outillés pour adopter et mettre en oeuvre le RDIBO, car trop théorique et déconnectée du stade de mise en oeuvre dans leur propre organisme.
Conclusion : La tenue d’ateliers est une approche fréquemment utilisée pour encourager l’adoption de nouvelles pratiques dans les milieux de soins de santé. Cependant, ils sont peu susceptibles de conduire à des changements de pratique significatifs à long terme. Les résultats sont discutés dans l’optique d’une réflexion sur le processus de transfert de connaissances.
Mots-clés :
- Formation,
- mise en oeuvre,
- services de soins de santé,
- dépendance,
- repérage,
- interventions brèves,
- transfert de connaissances
Abstract
Objective: Substance abuse is a public health concern worldwide. Frontline health care professionals (HCP) are well placed to provide screening, brief intervention and referral to treatment (SBIR) for patients with substance abuse. There are many challenges to implementation of SBIR in clinical practice and widespread adoption has been slow. The objective of this research was to explore the experience of frontline HCPs in training workshops mandated by the Ministry of Health and Social Services in Quebec, and to explore the gap between training and implementation into practice.
Methods: Two focus groups with ten frontline HCPs who had attended the mandated workshops were conducted and, in a second phase, 69 questionnaires were completed by HCP, among which 22 had attended the workshop. The study was conducted in Health and Social Service Centres that were in the process of implementing frontline services for substance abuse in response to government mandates.
Results: Participants felt that the training provided did not adequately equip them to adopt or implement SBIR. The training was perceived as too theoretical, and disconnected from their organization’s stage of implementation. While some reported that the training was helpful in increasing knowledge, participants reported minimal use of the training tools and few concrete changes in clinical practice post-workshop.
Conclusion: Workshops are a commonly used approach for promoting the uptake of new practices in health care settings ; however, they are unlikely to lead to significant long-term changes in practice. The results are discussed in the context of issues related to knowledge translation and the best practices for training.
Keywords:
- Training,
- implementation,
- healthcare services,
- substance abuse,
- screening,
- brief intervention,
- knowledge translation
Resumen
Objetivo: Quienes intervienen en primera línea están en posición ideal para proporcionar servicios de identificación, detección, intervenciones breves y orientación (IDIBO) a los pacientes que presentan un problema de dependencia. Por el contrario, la puesta en marcha del servicio IDIBO en la práctica clínica plantea numerosos desafíos y su adopción generalizada resulta lenta. El objetivo general de esta investigación es el de analizar las experiencias vividas por los intervinientes de primera línea que han seguido los talleres de formación del Ministerio de Salud y Servicios Sociales (MSSS) para poner en marcha el programa de servicios a las dependencias y, a continuación, estudiar la relación entre esta formación y la integración de los conocimientos adquiridos en la práctica.
Métodos: se realizó una discusión focalizada en dos grupos con un total de 10 intervinientes de primera línea y, en una segunda etapa, se distribuyeron 69 cuestionarios a otros intervinientes, 22 de los cuales tuvieron la ocasión de seguir la formación del Ministerio. Todos los intervinientes provenían de un Centro de Salud y Servicios Sociales (CSSS) que estaba en proceso de instaurar los servicios de primera línea sobre dependencias, tal como lo exige el programa de servicios en materia de dependencia del MSSS.
Resultados: si bien la formación a contribuido a aumentar el conocimiento de los participantes sobre la dependencia, los mismos manifestaron haber utilizado poco las herramientas de formación y haber aportado pocos cambios concretos a su práctica clínica con posterioridad al taller. Además, los participantes consideran que la formación dispensada no les ha proporcionado suficientes herramientas para adoptar y poner en práctica el servicio IDIBO, considerándolo demasiado teórico y desconectado del estadio de la puesta en marcha en su propio organismo.
Conclusión: la realización de talleres es un enfoque utilizado con frecuencia para alentar la adopción de nuevas prácticas en los medios de atención de la salud. Sin embargo, estos talleres son poco susceptibles de producir cambios de práctica significativos a largo plazo. Los resultados se discuten en la óptica de una reflexión sobre el proceso de transferencia de conocimientos.
Palabras clave:
- formación,
- puesta en marcha,
- servicios de atención de la salud,
- dependencia,
- identificación,
- intervenciones breves,
- transferencia de conocimientos
Appendices
Bibliographie
- Alvarez-Bueno, C., Rodriguez-Martin, B., Garcia-Ortiz, L., Gomez-Marcos, M. A. et Martinez-Vizcaino, V. (2015). Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews. Preventive Medicine, 76, S33-38. doi: 10.1016/j.ypmed.2014.12.010
- Anderson, P., Kaner, E., Wutzke, S., Funk, M., Heather, N., Wensing, M., … Group, W. H. O. B. I. S. (2004). Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol and Alcoholism, 39(4), 351-356. doi: 10.1093/alcalc/agh072
- Angus, C., Latimer, N., Preston, L., Li, J. et Purshouse, R. (2014). What are the Implications for Policy Makers? A Systematic Review of the Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care. Front Psychiatry, 5, 114. doi: 10.3389/fpsyt.2014.00114
- Babor, T. F. et Higgins-Biddle, J. C. (2000). Alcohol screening and brief intervention: dissemination strategies for medical practice and public health. Addiction, 95(5), 677-686.
- Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K. et Bray, J. (2007a). Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7-30. doi: 10.1300/J465v28n03_03
- Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K. et Bray, J. (2007b). Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7-30. doi: 10.1300/J465v28n03_03
- Barwick, M., Bennett, L., Johnson, S., McGowan, J. et Moore, J. (2012). Training health and mental health professionals in motivational interviewing: A systematic review. Children and Youth Services Review, 34, 1786-1795.
- Beidas, R. et Kendall, P. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology, 17(1), 1-30.
- Bernstein, E., Bernstein, J. A., Stein, J. B. et Saitz, R. (2009). SBIRT in emergency care settings: are we ready to take it to scale? Academic Emergency Medicine, 16(11), 1072-1077.
- Bhattacharyya, O. et Zwarenstein, M. (2009). Methodologies to evaluate effectiveness of knowledge translation interventions. Dans S. Straus, J. Tetroe & I. Graham (dir.), Knowledge translation in health care: moving from evidence to practice (p. 249-260). UK: Wiley-Blackwell.
- Broyles, L. M. et Gordon, A. J. (2010). SBIRT implementation: moving beyond the interdisciplinary rhetoric. Substance Abuse, 31(4), 221-223.
- Edlund, M. J., Unutzer, J. et Wells, K. B. (2004). Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities. Medical Care, 42(12), 1158-1166.
- Fairburn, C. G. et Cooper, Z. (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy, 49, 373-378. doi: 10.1016/j.brat.2011.03.005
- Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. et Wallace, F. (2005). Implementation research - A synthesis of the literature. Tampa, Florida: National Implementation Research Network.
- Gill, K. J., Campbell, E., Gauthier, G., Xenocostas, S., Charney, D. et Macaulay, A. C. (2014). From policy to practice: implementing frontline community health services for substance dependence–study protocol. Implementation Science, 9(1), 108.
- Glass, J. E., Hamilton, A. M., Powell, B. J., Perron, B. E., Brown, R. T. et Ilgen, M. A. (2015). Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction, 110(9), 1404-1415. doi: 10.1111/add.12950
- Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W. et Strang, J. (1995). The severity of dependence scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction, 9(5), 607-614.
- Heather, N. (2014). The efficacy-effectiveness distinction in trials of alcohol brief intervention. Addiction Science & Clinical Practice, 9, 13.
- Humeniuk, R. E., Henry-Edwards, S., Ali, R. L., Poznyak, V. et Monteiro, M. (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Manual for use in primary care. Geneva: World Heath Organisation.
- Johnson, M., Jackson, R., Guillaume, L., Meier, P. et Goyder, E. (2011). Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. Journal of Public Health, 33(3), 412-421. doi: 10.1093/pubmed/fdq095
- Kaner, E. F., Beyer, F., Dickinson, H. O., Pienaar, E., Campbell, F., Schlesinger, C.,… Burnand, B. (2007). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev (2), Cd004148. doi: 10.1002/14651858.CD004148.pub3
- Kaner, E. F., Dickinson, H. O., Beyer, F., Pienaar, E., Schlesinger, C., Campbell, F., . . . Heather, N. (2009). The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug Alcohol Review, 28(3), 301-323. doi: 10.1111/j.1465-3362.2009.00071.x
- Lopez, M., Osterberg, L., Jensen-Doss, A. et Rae, W. (2010). Effects of workshop training for providers under mandated use of an evidence-based practice. Administration and Policy in Mental Health and Mental Health Services Research (4), 301-312.
- Lyon, A., Stirman, S., Kerns, S. et Bruns, E. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238-253.
- Madras, B., Compton, W., Avula, D., Stegbauer, T., Stein, J. et Clark, H. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99, 280-295.
- MSSS (2006). Unis dans l’action : Plan d’action interministériel en toxicomanie 2006-2011. Québec : Gouvernement du Québec
- MSSS (2007). Unis dans l’action : Offre de service 2007-2012 - Programme-services Dépendances : Orientations relatives aux standards d’accès, de continuité, de qualité, d’efficacité et d’efficience. Québec : Gouvernement du Québec.
- MSSS (2009). Unis dans l’action : Programme de formation en dépendances pour les centres de santé et de services sociaux (CSSS). Québec : Gouvernement du Québec.
- Neushotz, L. A. et Fitzpatrick, J. J. (2008). Improving substance abuse screening and intervention in a primary care clinic. Archives of Psychiatric Nursing, 22(2), 78-86. doi: 10.1016/j.apnu.2007.04.004
- Nilsen. (2010). Brief alcohol intervention. Where to from here? Challenges remain for research and practice. Addiction, 105(6), 954-959. doi: 10.1111/j.1360-0443.2009.02779.x
- Nilsen, P., Kaner, E. et Babor, T. (2008a). Brief intervention, three decades on. Nordic studies on alcohol and drugs, 25(6), 453-467.
- Nilsen, P., Kaner, E. et Babor, T. F. (2008b). Brief intervention, three decades on - An overview of research findings and strategies for more widespread implementation. Nordic Studies On Alcohol and Drugs, 25(6), 453-467.
- Nygaard, P. et Aasland, O. G. (2011). Barriers to implementing screening and brief interventions in general practice: findings from a qualitative study in Norway. Alcohol Alcohol, 46(1), 52-60. doi: 10.1093/alcalc/agq073
- O’Donnell, A., Wallace, P. et Kaner, E. (2014). From efficacy to effectiveness and beyond: what next for brief interventions in primary care? Front Psychiatry, 5, 113. doi: 10.3389/fpsyt.2014.00113
- Paquin, C. (2014). Portrait statistique de la population du territoire du CSSS de la Montagne 2011. Montréal, Québec : Centre de santé et de services sociaux de la Montagne.
- Polen, M. R., Whitlock, E. P., Wisdom, J. P., Nygren, P. et Bougatsos, C. (2008). Screening in Primary Care settings for Illicit Drug Use: Staged Systematic Review for the United States Preventive Task Force. Evidence Synthesis, 58(1), 1-67.
- Raistrick, D., Dunbar, G. et Davidson, R. (1983). Development of a questionnaire to measure alcohol dependence. British Journal of Addiction, 78(1), 89-95.
- Ritchie, J. et Spencer, L. (1993). Qualitative data analysis for applied policy research. London: Routledge.
- Rogers, E. M. (2002). Diffusion of preventive innovations. Addictive behaviors, 27(6), 989-993.
- Saitz, R. (2014). Screening and brief intervention for unhealthy drug use: little or no efficacy. Front Psychiatry, 5, 121. doi: 10.3389/fpsyt.2014.00121
- Sandelowski, M. (2000). Whatever happened to qualitative description? Res Nurs Health, 23(4), 334-340.
- Seale, J. P., Velasquez, M. M., Johnson, J. A., Shellenberger, S., von Sternberg, K., Dodrill, C., … Grace, D. (2012). Skills-based residency training in alcohol screening and brief intervention: results from the Georgia-Texas “Improving Brief Intervention” project. Substance abuse, 33(3), 261-271.
- Stanton, M., Atherton, W., Toriello, P. et Hodgson, J. (2012). Implementation of a «learner-driven» curriculum: An screening, brief intervention, and referral to treatment (SBIRT) interdisciplinary primary care model. Substance Abuse, 33(3), 312-315.
- Stuart, G., Tondora, J. et Hoge, M. (2004). Evidence-based teaching practice: Implications for behavioral health. Administration and Policy in Mental Health, 32(2), 107-130.
- Tremblay, J. et Blanchette-Martin, N. (2009). Manuel d’utilisation du DÉBA-Alcool/Drogues/Jeu. Trois-Rivières, Québec.
- Young, M. M., Stevens, A., Galipeau, J., Pirie, T., Garritty, C., Singh, K., … Moher, D. (2014). Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Systems Review, 3, 50.