Proceedings of the 16th Annual Conference on the Science of Dissemination and Implementation in Health

Background:The Psychiatric Collaborative Care Model (CoCM) is a highly evidence-based model of behavioral health care delivery in primary care settings.Rural primary care (RPC) clinics may face unique barriers to implementation of CoCM that are important for implementation teams to understand.As part of a multisite implementation of CoCM in RPC clinics, we explored primary care staff and practice facilitator (PF) perspectives on barriers and promising implementation strategies for CoCM implementation.Methods: This study followed a sequential explanatory mixed methods design.Clinics (n=23) were each assigned a trained PF who they met with monthly for 15 months to support CoCM implementation.Quantitative data included structured surveys completed by PFs at the conclusion of each monthly meeting with individual clinics (n=459 surveys) that asked PFs to report the frequency and strength of 16 pre-determined influencing factors for implementation.Survey data were analyzed descriptively and informed qualitative data collection.Qualitative data included key informant interviews with a purposive sample of 9 clinic staff and 2 PFs to expand on implementation experiences and recommended strategies.Qualitative analysts double-coded all transcripts using Rapid Assessment Process and a combination of inductive coding to identify themes and deductive coding to map implementations strategies to ERIC strategies.Findings: All clinics (n=23) were located in low population density areas (average RUCA classification: 7).At baseline, 91% of clinics reported readiness for CoCM implementation.The strongest and most frequently-reported barriers reporting during implementation were: 1) the impact of the COVID-19 pandemic, 2) limited availability of site staff to participate in implementation activities, and 3) hiring of new staff to fill CoCM roles.Qualitative data further characterized the ways these barriers uniquely influenced RPC settings, including themes related to the influence of remote location, increased billing complexities, and maintaining a community focus.To mitigate these challenges, implementation teams emphasized the strategies of promoting adaptability, revising professional roles, identifying and preparing champions, and better organizing implementation meetings, offering several examples of strategies used in practice.Implications for D&I Research: RPC settings face unique challenges to CoCM implementation, however several promising implementation strategies -when tailored to RPC contexts -may help.