This doctoral-level chapter examines implementation barriers for evidence-based healthcare interventions, specifically analyzing the Comprehensive Addiction and Recovery Act (CARA) and collaborative care models for bipolar disorder. The analysis identifies key obstacles including COVID-19 pandemic impacts, reimbursement challenges, and poor model comprehension that hinder successful program implementation. The research demonstrates how effective interventions often fail to reach practice due to systemic barriers rather than lack of clinical efficacy.
VanAtta opted to focus on Comprehensive Addiction and Recovery Act (CARA) as a response to battle opioid epidemic. As highlighted by my colleague, four programs on CARA were developed but have not been implemented fully. According to CADCA (2017), CARA expands educational and prevention efforts to prevent opioid use particularly on aging populations, caretakers, parents, and teens. In addition, the programs strengthen monitoring programs for drug prescription to enable states to track and monitor diversion of drug prescriptions (CADCA, 2017). Apart from the barriers to implementation of CARA that have been highlighted by my colleague, there exists other barriers to implementation. For instance, the COVID-19 pandemic has slowed the implementation of the act by limiting its ability to function properly based on grant applications (National Academies of Sciences, Engineering, and Medicine, 2021).
Obinna opted to focus on the study by Bauer and company in 2006 that was successfully researched, but whose findings were not implemented. The said study consisted of the collaborative care model for bipolar disease. According to Bauer et al. (2006), the said model is an intervention that helps improve the self-management skills of patients by enhancing information flow, continuity of care, access to care; supporting decision making; and through psychoeducation. Results from the study showed that the collaborative care model improves bipolar disorder outcomes in clinical practice. However, despite the efficacy of the said model, as highlighted by my colleague, it would be prudent to note that the findings of the said study were not implemented as expected owing to certain barriers to implementation. Apart from the implementation barriers that my colleague has highlighted, there exists other barriers to implementation of the collaborative care model. For instance, Smith et al. (2021) suggest that challenges in reimbursement and poor comprehension of the collaborative care model are potential barriers to implementation of the said model.
Bauer, M. S., McBride, L., Williford, W. O., Glick, H., Kinosian, B., Altshuler, L., Beresford, T., Kilbourne, A. M., Sajatovic, M. & Cooperative Studies Program 430 Study Team. (2006). Collaborative care for bipolar disorder: part I. Intervention and implementation in a randomized effectiveness trial. Psychiatric Serv, 57(7), 927-36.
CADCA (n. d). The Comprehensive Addiction and Recovery Act (CARA). https://www.cadca.org/comprehensive-addiction-and-recovery-act-cara
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