Table 3.

Barriers and facilitators by CFIR construct.

CFIR construct and definition	Barriers	Facilitators
Characteristics of individuals
Knowledge and beliefs about the innovation	Attitudes about screening tools, knowledge of screening tools, emotionally exhausting, belief in responsibility to provide MAT	Belief in treatment efficacy, belief in his/her responsibility to treat the population, belief in responsibility to provide MAT
Individual identification with organization	Organization not supportive of implementing MAT clinic	Desire to “align with organizational policy”
Individual stage of change		Intent to implement [MAT] once organization is supportive
Self-efficacy	Ability to assess risk, confidence in implementing MATs	Ability to assess risk in patients using tool or clinical expertise
Other personal attributes	Training, desire to treat population	Training, desire to treat population
Innovation Characteristics
Complexity	Screening tools are “cumbersome”	Screening tools easy to use
Cost	Alternative treatments, buprenorphine waiver, general cost to patients of treatments
Evidence strength and quality	Lack of evidence for psychosocial treatments, generalizability of research results, lack of evidence of benefit of taper
Inner setting
Implementation climate		Integrated system
Compatibility	Policy is to refer OUD patients out
Goals & feedback	Using a single metric
Learning climate		Being in an academic institution, teaching students
Relative priority	Organizational support for MAT clinics, organization does not want responsibility	Providing certain treatments gives organization a “leg up” on competition, established group to support implementation
Networks and communications	Provider does not work with team	Team-based approach to treatment. Ability to communicate with patient’s other providers
Readiness for implementation
Available resources	Access to non-pharmacologic treatments, time	Access to non-pharmacologic therapies, access to risk assessment tools
Outer setting
External policies & incentives	Absence of PDMP, misinterpretation of guidelines by policymakers and media	PDMP, state-funded MAT team
Needs & resources of those served by the organization	Patient access to therapies, patient perception of efficacy of treatments	Ability to tailor approach to patient needs
Process
Planning	Lack of institutional support	Obtaining a waiver to prescribe medications for OUD, institutional support
Engaging		Engagement of team members
Executing		Successfully assembling a team
Reflecting and evaluating	Lack of appropriate quality and performance metrics

Note. CFIR = Consolidated Framework for Implementation Research; MAT = medication-assisted treatment; OUD = opioid use disorder; PDMP = prescription drug monitoring program.