The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample
Open accessAbstract
BACKGROUND: Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally. METHODS: A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed. RESULTS: A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment. CONCLUSIONS: These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.
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“others have found that “more is not always better” [63–65]”
From A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022 (2024) · cites this paper as [63]
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Self-citationYakovchenko, V., Morgan, T. R., Chinman, M. J., Powell, B. J., Gonzalez, R., Park, A., Malone, P. S., Chartier, M., Ross, D., & Rogal, S. S. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-07312-4 · Cited by 27 · see citing works
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- Authors
- Rogal, S. S., Yakovchenko, V., Waltz, T. J., Powell, B. J., Kirchner, J. E., Proctor, E. K., Gonzalez, R., Park, A., Ross, D., Morgan, T. R., Chartier, M., & Chinman, M. J.
- Affiliations
- University of Pittsburgh (US)
- Edith Nourse Rogers Memorial Veterans Hospital (US)
- Eastern Michigan University (US)
- University of North Carolina at Chapel Hill (US)
- Central Arkansas Veterans Healthcare System (US)
- Washington University in St. Louis (US)
- VA Long Beach Healthcare System (US)
- VA Boston Healthcare System (US)
- Veterans Health Administration (US)
- RAND Corporation (US)
- Corresponding author
- Rogal, Shari S.
- ORCID
- Venue
- Implementation Science
- Published
- 2017-05-11
- Volume
- 12
- Issue
- 1
- Pages
- 60-60
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC5425997
- OpenAlex
- W2612299727
- Cited by
- 98
- References
- 20
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 16 · 2023: 15 · 2022: 9 · 2021: 13 · 2020: 12 · 2019: 12 · 2018: 5 · 2017: 2
- FWCI
- 13.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- UNC Libraries
- Funders
- HIV, Hepatitis and Related Conditions Programs in the Office of Specialty Care Services of VHA
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- hepatitis C, implementation strategies, Expert Recommendations for Implementing Change, evidence-based practice uptake, veterans, Veterans Health Administration, implementation evaluation, treatment initiation
- MeSH terms
- Assessment of Medication Adherence, Adult, Antiviral Agents, Female, Hepatitis C, Humans, Male, Middle Aged, United States, United States Department of Veterans Affairs, Veterans, Drug Monitoring, Medication Adherence
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