Bridging the evidence-to-practice gap: a stepped-wedge cluster randomized controlled trial evaluating practice facilitation as a strategy to accelerate translation of a multi-level adherence intervention into safety net practices

• Published in: Implementation science communications 2021-02, Vol.2 (1), p.21-21, Article 21
• Main Authors: Schoenthaler, Antoinette, De La Calle, Franzenith, Soto, Amanda, Barrett, Derrel, Cruz, Jocelyn, Payano, Leydi, Rosado, Marina, Adhikari, Samrachana, Ogedegbe, Gbenga, Rosal, Milagros
• Format: Article
• Language: English
• Subjects: Antihypertensives; Electronic health records; Hypertension; Intervention; Latino persons; Medication adherence; Patient compliance; Practice facilitation; Primary care; Study Protocol
• ISSN: 2662-2211; 2662-2211
• DOI: 10.1186/s43058-021-00111-2

Poor adherence to antihypertensive medications is a significant contributor to the racial gap in rates of blood pressure (BP) control among Latino adults, as compared to Black and White adults. While multi-level interventions (e.g., those aiming to influence practice, providers, and patients) have been efficacious in improving medication adherence in underserved patients with uncontrolled hypertension, the translation of these interventions into routine practice within "real world" safety-net primary care settings has been inadequate and slow. This study will fill this evidence-to-practice gap by evaluating the effectiveness of practice facilitation (PF) as a practical and tailored strategy for implementing Advancing Medication Adherence for Latinos with Hypertension through a Team-based Care Approach (ALTA), a multi-level approach to improving medication adherence and BP control in 10 safety-net practices in New York that serve Latino patients. We will conduct this study in two phases: (1) a pre-implementation phase where we will refine the PF strategy, informed by the Consolidated Framework for Implementation Research, to facilitate the implementation of ALTA into routine care at the practices; and (2) an implementation phase during which we will evaluate, in a stepped-wedge cluster randomized controlled trial, the effect of the PF strategy on ALTA implementation fidelity (primary outcome), as well as on clinical outcomes (secondary outcomes) at 12 months. Implementation fidelity will be assessed using a mixed methods approach based on the five core dimensions outlined by Proctor's Implementation Outcomes Framework. Clinical outcome measures include BP control (defined as BP