Qualitative application of the RE-AIM/PRISM framework to an educational intervention for improving the care of persons with behavioral and psychological symptoms of dementia

Abstract

Background

An academic detailing model has improved self-efficacy of memory clinic clinicians to identify and manage complex behavioral and psychological symptoms in persons with dementia (BPSD). The purpose of this report is to describe a systematic approach to adapting a clinician education program previously delivered in two primary care integrated memory clinics for improving the management of BPSD to also be deliverable outside a memory clinic setting, in generalist primary care clinics. The RE-AIM/PRISM implementation framework guided the approach.

Methods

Application of the RE-AIM/PRISM framework to the academic detailing program for BPSD was mapped. Framework-guided qualitative interviews were completed with experienced (Champion) and inexperienced (Novice) program stakeholders including questions on perceived gaps in clinical care (BPSD management) and barriers and facilitators to the educational model. Inductive and deductive qualitative thematic analytic approaches were used, the latter organized by RE-AIM domains and multi-level context. Convergence or divergence in organized themes by stakeholder experience shaped examination of fit and interactions among domains, components and strategies of the model for pre-implementation adaptations planning for non-memory clinic primary care clinicians.

Results

A pragmatic application of the RE-AIM/PRISM framework was completed for collecting qualitative feedback from stakeholders, identifying multi-level contextual barriers and facilitators, and planning adaptations to our clinician education program. A description of the clinician stakeholders, the approach and one example of a clinician and intervention-level theme identified across RE-AIM domains for the program, self-efficacy in the management of BPSD, and resulting planned adaptations were shared.

Conclusions

We provide a novel qualitative application of the RE-AIM/PRISM framework to inform adaptations for an intervention for primary care that incorporates feedback from both current experienced and future inexperienced program stakeholders. This approach can be used to identify multi-level contextual barriers and facilitators to reach, adoption, implementation, and effectiveness of this clinician education programs approach, academic detailing, for future primary care teams.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-025-00754-5.

Contributions to the literature.

• Frameworks such as the combined RE-AIM/PRISM framework should be used more frequently during the design and adaptation stages of dementia care programs to recognize and address internal and external contextual factors that may influence program implementation.

• We model a novel approach to incorporate stakeholder feedback that varies by experience, to inform adaptations for non-memory clinic-based primary care settings for an educational intervention.

• This approach adds to the growing literature recommending qualitative application of the RE-AIM/PRISM framework and may guide future researchers to identify multi-level contextual barriers and facilitators to reach, adoption, implementation, and effectiveness for clinician education programs.

Background

Behavioral and psychological symptoms occur frequently in persons living with dementia and their management is complex [1–3]. A person-centered approach requires clinicians and their teams to understand and act on a myriad of multifactorial causes [4, 5], determining the best nonpharmacologic, pharmacologic, medical or combination of approaches for treatment [1–3, 6, 7]. As might be expected, primary care clinicians, from whom most persons with behavioral and psychological symptoms of dementia (BPSD) receive their care [8, 9], have reported lacking the knowledge and self-efficacy for managing these complex behaviors [10, 11]. A growing lack of access to specialty geriatric care [8, 9] and limited established pathways to expert clinical guidance are added challenges for dementia care in primary care. Some organizations have integrated dementia or memory care clinics into their family medicine practices to meet these growing demands [12, 13].

An intervention that combines two complementary approaches, the academic detailing model [14] and the DICE Approach™ (DICE) [15], “Dementia Educational Techniques: Academic detailing and DICE” (DETAILD), was developed to better equip primary care clinicians and their teams to identify and manage BPSD. A pilot study of the academic detailing model among clinicians practicing in primary care integrated memory clinics demonstrated increased clinicians’ knowledge and attitudes about BPSD and dementia, and high satisfaction with the intervention [12, 16]. For that pilot, 11 academic detailing sessions were offered to clinicians over 18 months; each session (lasting 1.5–2 h) consisted of a 30-min didactic presentation on a determined topic, case discussions and, when scheduled, in-session patient consultations. Following completion of a web-based modular training program, six sessions were held separately with staff for in-depth discussions of the DICE Approach™ [15] (Table 1). Further program development plans include expanding the training audience for delivery in more varied primary care settings, and testing the efficacy of the program delivered in these settings to improve outcomes for persons living with dementia and for their family caregivers.

Table 1.

The DETAILD model

Intervention component	Original DETAILD model	Practice facilitators [3]
Interdisciplinary audience	Academic detailing sessions with clinicians, DICE overview with clinicians, DICE in-depth with clinic staff	MD and DNP with expertise in: AD, non-pharmacologic and pharmacologic management of BPSD and DICE; MD and DNP with clinicians; SW with expertise in DICE; DNP and SW with staff
Outreach	Clinician and staff presentations
Visit schedule	Mix of monthly, bi-monthly or tri-monthly sessions over 18 months with clinicians; Monthly sessions with staff over 6 months
Time	1.5–2 h/visit for AD, 1 h/visit for DICE
Format of session	Didactics; 1–2 case discussions; case consultation with clinicians and/or staff
Content of curriculum	Clinician sessions with pre-determined content and with tailored content; Pre-determined DICE content with staff
Learning materials	In-person didactics; Self-directed web-based DICE training modulesa for staff

Abbreviations: AD Academic Detailing, BPSD Behavioral and psychological symptoms of dementia, DICE ‘Describe, Investigate, Create and Evaluate’ Approach, DNP Doctor of Nursing Practice, SW Social Work

^a[15], available through the University of California-Davis

Implementation frameworks are critical to real-world implementation success, but they have been used infrequently to guide dementia care programming during intervention design stages [17–19]. The RE-AIM implementation framework has been used extensively to guide program implementation and evaluation in both community and healthcare settings [20–23]. RE-AIM has also been used to evaluate implementation of dementia care programs [17, 18] as well as clinician education programs [23–26]. When integrated with the Practical, Robust, Implementation and Sustainability Model (PRISM), the combined RE-AIM/PRISM framework spurs consideration of internal and external context, the fit between context and intervention components, and their influence on implementation [20, 27], fitting for adapting this dementia educational program and its implementation within clinical settings. Qualitative application of the framework has recently been encouraged [20, 28]. Specifically, a pragmatic qualitative application of the program can provide a deeper understanding of the a) contextual factors impacting who the program reaches, b) reasons for adoption of the program and program effectiveness, and c) barriers and facilitators for implementation [28–30].

The purpose of this report is to share the systematic and pragmatic approach to identifying adaptions for our clinician education program for improving the management of BPSD across primary care settings. We then share examples of how findings from this qualitative approach guided adaptations.

Methods

Overview of study design

A qualitative descriptive study [31] was designed to incorporate the views of clinician stakeholders in our re-examination of the academic detailing model and its implementation for generalist (non-memory clinic) primary care clinics. We used the RE-AIM/PRISM framework [20] for developing pre-implementation adaptations, following a descriptive stakeholder-engaged qualitative approach to keep close to clinician participants’ perceptions and experiences of the program [32] while identifying a) gaps in BPSD management in primary care and b) multi-level contextual barriers and facilitators to academic detailing and its implementation in primary care. The enhanced RE-AIM/PRISM framework was applied throughout the study, first in framing the qualitative interview questions, then in their analysis and interpretation of findings, in order to identify and subsequently respond to contextually relevant barriers and facilitators for each domain of the academic detailing program and its future implementation. This application is shown in Fig. 1.

Fig.1.

Application of the revised, enhanced RE-AIM/PRISM 2019 Model [20] for intervention adaptation and implementation planning. Abbreviations: RE-AIM, Reach, Effectiveness, Adoption, Implementation and Maintenance; PRISM, Pragmatic, Robust, Implementation and Sustainability Model, DICE, ‘Describe, Investigate, Create and Evaluate’ Approach

The protocol for the study was approved by the Institutional Review Board for the University of Wisconsin-Madison, including a waiver for providing written consent. Individuals instead provided verbal consent and documented their consent through an electronic survey.

Clinician stakeholders

Feedback was sought from clinicians with varied representation of practice and program experience, including clinicians in family internal medicine, practicing within or outside a memory clinic, and with and without experience in the educational model. Stakeholders were first purposively identified among clinicians who practiced in two distinct healthcare systems with a clinic membership in the Wisconsin Alzheimer’s Institute Dementia Diagnostic Clinic Network [12]. Clinicians in family medicine, internal medicine or behavioral health, primarily those who practiced in the memory clinic at these sites, had previously participated in a pilot study of academic detailing to improve their management of BPSD [16]. Clinicians referred to as program ‘Champions,’ encouraged others to participate in DETAILD, supported implementation by bringing cases for discussion and consultation and participated in half or more of the previous pilot academic detailing sessions. Those clinicians who practiced outside the memory clinic with little to no academic detailing experience were categorized as program ‘Novices.’

Clinicians at one of the memory clinic sites also participate in the Wisconsin Research and Education Network (WREN), a statewide primary care practice-based research network (PBRN) [33]. Clinicians in this network were surveyed separately to assess potential gaps in BPSD management and continuing education method preferences in primary care [34]. A subset of respondents to that survey (7 out of 46), who expressed having potential gaps in BPSD management and elected to be contacted by email formed a convenience sample of clinicians without experience in DETAILD, also invited by the program manager to participate in Novice interviews.

Application of the RE-AIM/PRISM framework – qualitative interviews

A semi-structured qualitative interview approach was employed with interview questions pragmatically following the RE-AIM domains of reach, effectiveness, adoption, and implementation [20]. Stakeholders were invited to participate by the clinic administrator or the program manager. Email invitations were administered by an electronic REDCap database [35] hosted by the Department of Medicine at the University of Wisconsin-Madison School of Medicine and Public Health. Interviews were completed until the sample had been exhausted for Champions, or for Novices who were willing to participate.

Question topics are presented in Table 2 and did not change over the study. Two interview guides were designed with distinct questions asked for the program Champions and Novices pertaining to each of the domains.

Table 2.

Interview question topics for addressing barriers and facilitators by RE-AIM domain, for program champions and novices

RE-AIM Dimension	Champion Topic	Novice Topic
Reach • Target audience	• Approach and challenges to caring for persons with BPSD • Opportunities for continuing to improve ability to manage BPSD	• Approach and challenges to caring for persons with BPSD • Areas for improvement in managing persons with BPSD
Adoption • Participation	• Participation in AD and case-based learning • DICE participation • Scale up of AD and DICE	• Participation in AD and case-based learning
Implementation • Application methods	• Utility of AD to practice for management of BPSD • Implementation of learned approaches	• Integrating evidence-based practices, such as AD approach into practice for management of BPSD
Effectiveness • Impact	• Effectiveness of approach and case-based learning

Abbreviations: AD Academic Detailing, BPSD Behavioral and psychological symptoms of dementia, DICE ‘Describe, Investigate, Create and Evaluate’ Approach

Reach

Stakeholders were asked to explore gaps in their abilities to manage BPSD. Professional and demographic information were collected to support descriptions of those engaged in the program and the representativeness of engaged audiences. This was to frame understanding of the factors impacting who the program should reach, to guide audience selection and recruitment strategies, and learn how to best shape program access and fit for audiences intended to benefit from the program.

Adoption

Questions on program adoption queried on reasons and supports for participation in academic detailing and how to address the challenges clinicians described. This inquiry sought to provide understanding of factors that could impact participation among those who engaged and inform approaches to a) address or b) build on, identified barriers and facilitators to participation, respectively, for future delivery.

Implementation and effectiveness

Questions that pertained to implementation and effectiveness asked stakeholders on the utility and feasibility of implementing evidence-based practice facilitation such as academic detailing to improve management of BPSD, the key intervention components and implementation strategies of detailing for successful implementation and effectiveness, and how learned approaches/evidence-based practices could be integrated into their care of persons with BPSD. These findings sought to inform whether and what adaptations to program content and implementation strategies may be warranted for maximizing program impact.

Questions also considered the internal and external context for academic detailing as being multi-level barriers or facilitators that may influence these domains, as specified by the PRISM model and following from recent literature on dementia care program implementation [18, 36]. Context was probed by asking clinicians to address how they, their organizational and clinic setting or team, or the persons living with dementia and caregivers they serve, may affect each of the questioned upon features of reach, adoption, implementation and effectiveness of academic detailing. Clinicians were grouped by their level of prior participation in academic detailing (as Champions or Novices) for both interviews and analysis.

Application of the RE-AIM/PRISM framework—qualitative analysis

Qualitative analysis was performed on transcribed interview content using both inductive and deductive approaches [36], the latter approach incorporating both the RE-AIM framework and multi-level domains (organization, clinician, intervention, and persons living with dementia and caregivers) [37], to help organize data to inform intervention or implementation revision by level of impact, and future reach, adoption, implementation, and effectiveness of the program. At least three analysis team members independently reviewed each interview transcript. The multi-disciplinary research team included those with applied and varied clinical (JS, TA, SS, CC, AW), community (MS, TL, SH, CC, AW) and research-related (TL, UP, SS, CC, AW) dementia care experience. The analysis team, a subset of above, was varied by gender and these experiences, including clinical care (JS, TA), social work (MS) and public health (TL, UP, TA) backgrounds. Two of five members conducted interviews (MS, JS).

Inductive, thematic analysis began with the team members independently performing open coding of Champion transcripts without reference to frameworks and reviewing each response for thematic categories arising from the response without interpretation.

Researchers re-reviewed interview content and themes for questions in the RE-AIM domain areas (reach, adoption, or implementation/effectiveness) and attached a label for contextual level impacted by the barrier or facilitator, as 1) clinician, 2) organization, 3) intervention, or 4) person living with dementia or caregiver [37]. The coding framework and approach was then applied to the Novice interviews while encouraging new themes to also emerge. This grouping and order was purposeful, reflecting our having distinct interview guides tailored to each group and to ensure recognizing and comparing distinct content provided by each experience group.

Application of the RE-AIM/PRISM framework – interpretation of findings

Further interpretation and deductive organizing steps were completed across the team for reporting. Convergence or divergence in organized themes by stakeholder experience shaped examination of fit and interactions among domains, components and strategies of the model for pre-implementation adaptations planning, for non-memory clinic-based primary care clinicians. Themes were organized in grids by contextual level to draw comparisons by domain and across contextual level to evaluate for convergence of themes, or fit, across program components, implementation strategies, and contextual factors. Themes were also compared by experience group—for Champions and Novices—within and across RE-AIM domains and contextual levels to understand how themes converged or diverged by BPSD practice experience.

Figure 1 depicts application of the enhanced RE-AIM/PRISM model to interpretation of qualitative findings and planning, where consideration of intervention components, implementation strategies, and themes reflecting internal and external contextual factors, their fit and interactions, were examined.

Results

Fourteen clinicians were interviewed, seven Champions and seven Novices participated during December 2022 through August 2023. Most clinicians interviewed were White (93%), 65% were female, 64% were physicians and all were non-Hispanic or Latino. Both Champions and Novices included clinicians practicing in Family Medicine and Internal Medicine, and in urban and rural settings. Most (71%) practiced at a site that hosted a memory clinic, 64% practiced at a WREN PBRN participating site. Clinician practice settings included office-based, hospital-based, academic medical center and federally qualified health center clinics (Supplemental Table 1).

Themes pertaining to the intervention and organizational, clinician and healthcare team context emerged for implementation planning. We provide as example one theme, the comparison and contrast of perceptions within that theme for Champions and Novices, and how this information shaped the planned adaptations. A theme with impact at the level of clinician and implementation strategy with broad reaching implications for improving program fit, pertaining jointly to the reach, adoption and effectiveness domains was chosen and is shared in brief (Table 3). A separate manuscript presents detailed qualitative results including comparisons made across all themes identified by Champions and Novices (Albrecht T, LeCaire TJ, Schroeder M, Stone J, Paniagua U, Peng S, Houston S, Schrager S, Carlsson CM, Walaszek A. Understanding primary care clinician experience managing behavior and psychological symptoms of dementia using DETAILD, submitted).

Table 3.

Example theme and adaptations pertaining to program fit, with impact at the level of clinician and implementation strategy

Theme: Self-efficacy in the management of BPSD
Reach, Adoption & Effectiveness: Program Fit
Domains	Champion	Novice	Adaptations
Reach	Case-based applied learning builds confidence; Continuous experiential learning caring for persons with BPSD builds confidence; Appropriate for clinicians with less experience & training	Case-based applied learning builds confidence; Gap in self-efficacy due to limited experience caring for persons with BPSD; Appropriate for clinicians with less experience & training	Address value & effectiveness of the program, tailored for clinicians with less experience, in outreach with target audience members Introductory sessions of the program to emphasize basics, lack of direct care experience for generalist primary care clinicians Prepare tailored example case discussions to be most relevant to generalist primary care
Adoption	Case-based applied learning & continuous experiential learning caring for persons with BPSD builds confidence	Expected breadth of knowledge in primary care
Effectiveness	Effective for clinicians with less experience & training

Abbreviation: BPSD Behavioral and psychological symptoms of dementia

A theme pertaining to program reach with the audience, adoption of the program and program effectiveness that was tied to clinician-level impact as well as the program’s implementation strategy for both Novices and Champions, was self-efficacy for BPSD care. Champions acknowledged that case-based applied and continuous, experiential learning was offered through unique patient experiences in the care of persons with BPSD and that learning was never-ending when addressing behaviors and symptoms due to dementia: “…after a while, you realize that every day you’re learning something new…there’s books to be written about each and every patient and their story”. Building confidence through case-based applied, experiential learning was seen as a benefit for target audiences and reason for adoption of the program by Champions. Champions also reported the program would be especially appropriate and effective for clinicians with less experience and training.

Generalist Novices on the other hand reported lacking the direct care experience to identify individual needs of persons with BPSD: “…I’m not doing this day to day. I’m seeing these patients for short periods of time for, you know, critical evaluation. So, sometimes I feel like I can’t speak from personal experience or, you know, the perspective of really being that person on the ground.” This gap supported the need for the program to reach similarly less experienced audience members. In agreement with Champions, Novices also supported the appropriateness of the model and its case-based approach for building confidence. When Novice clinicians were queried on adoption of the program, a unique consideration to their building self-efficacy on managing BPSD was that the breadth of knowledge expected for primary care clinicians may serve as a barrier to adoption for some clinicians.

In this example, the academic detailing model, in seeking to improve self-efficacy for BPSD care, through experiences in applying learned approaches through case discussions and consultations, seemingly could fit the training needs for inexperienced clinicians. By bringing case-based, experiential learning to future Novice audience members, the program can address gaps and improve self-efficacy. An adaptation built on this theme, to guide buy in with target audiences and maximize program reach, was to emphasize the benefit of case experiences during academic detailing for building confidence regardless of the clinician’s current level of BPSD care experience. An additional adaptation, to address the gaps noted in direct care experience for BPSD by Novices, was to further tailor the content for generalist clinicians to include a more extensive introduction to identifying and managing BPSD during the program to address their limited experience, as well as tailored example case discussions to be most relevant to their needs. The resulting adaptations therefore addressed the lack of direct care experience through slight revision of the implementation strategy when generalist primary care clinicians are in the training audience. Future outreach with administration, clinicians and the healthcare team will also address value and effectiveness of the program for improving recruitment.

Discussion

Implementation planning during early stages of intervention development is promoted to safeguard “successful implementation in the real world” [19] and has been a recent priority in dementia care programming [19, 38, 39]. This study outlines our approach, which aligns with this priority. The approach follows recommendations to purposefully engage stakeholders and to include pragmatic application of an implementation framework, such as RE-AIM/PRISM, early in intervention design and implementation [40]. In this instance, during pre-implementation planning, we sought to understand the key underlying principles of our academic detailing model for management of BPSD and its implementation for primary care clinicians, and the barriers and facilitators that may affect success of the approach for clinicians and their organizations to improve the management of BPSD. Our intention was to collect and process feedback from stakeholders to inform adaptations to improve this academic detailing model’s reach, adoption, implementation and effectiveness, for delivery in family medicine or internal medicine primary care clinics where clinicians may otherwise refer to a memory clinic within their healthcare system. Our approach and findings thus far point to several unique needs to address for both experienced and inexperienced clinicians and the health care organizations in which they practice to ensure a broadly reaching educational program on BPSD care in primary care. The feedback stakeholders from the original context shared was fruitful for identifying aspects of the program that should not be adaptable as well as helping to highlight differences between experienced and non-experienced settings. A separate manuscript provides these results in detail.

In this report, we devised a comprehensive, context-based approach to implementation planning for our primary care-based educational program. The mixed experience of program stakeholders promoted deeper consideration of context for planning adaptations for varied primary care settings, well-supported by RE-AIM/PRISM. In this example, we focused on dementia care; by engaging primary care clinicians with and without experience in memory care and our training program, we identified some potentially more broadly reaching adaptations for improving reach, adoption, implementation and effectiveness of DETAILD, especially for primary care clinicians not practicing in memory care. We provided an example of how to operationalize multi-level context during analysis, and how this application resulted in consideration of the interaction and fit between DETAILD’s intervention components, implementation strategies, and RE-AIM outcomes. This approach addresses the reported lower levels of integrated use of PRISM [41] and is consistent with other recent reports that have highlighted the benefits of applying the RE-AIM/PRISM framework to support pre-implementation planning and adaptation for multi-level context [41, 42].

Projected shortages in primary care are especially urgent for the diagnosis and care of persons with Alzheimer’s disease or related dementias [43]. Therefore it remains important to have vetted clinical education approaches and expanded use of implementation sciences frameworks pre-implementation. Application of implementation frameworks for dementia care interventions has grown, yet few report on their use during intervention development or adaptations [44]. Greater use of implementation models, such as RE-AIM/PRISM, “through the life cycle of intervention development” as well as taking a “contextual-based approach” to systematically inform adaptations has been called for [19]. This approach benefits from the “intuitiveness and transparency of the RE-AIM model,” [45] pragmatic application of the RE-AIM dimensions, and the evolution of RE-AIM to focus on contextual and explanatory factors with linkage to PRISM [20]. As such, our systematic and integrated use of RE-AIM/PRISM has resulted in a “conceptual and data-driven” approach to our pre-implementation adaptations for primary care [46].

This work aligns with pre-implementation and implementation adaptive approaches presented by others in which engagement of stakeholders is key for developing needed practice adaptations to “improve fit between practice and context” [47–49]. Taking a qualitative approach with stakeholders supports in-depth discovery for planning adaptations [30, 50]. In this study, we provide a novel example of how to learn from Novices, those who were not engaged in the program but may be in the future. There is benefit in comparing themes across the topic Champions and Novices in application of RE-AIM/PRISM for understanding whether adaptations require modifications to content, context or both for adaptations across the RE-AIM domains for the subgroup of primary care clinicians with less experience in BPSD care [51]. Champion stakeholders are well-known to facilitate implementation, including through supporting readiness and buy-in at the organizational and individual level [52], therefore their insights also inform adaptations relevant to their Novice colleagues. Although for adapting the program to generalist primary care settings, further weight may be given to findings and context for Novices.

We provide an example of a systematic approach for future pre-implementation planners and continue to expand the pragmatic use of RE-AIM/PRISM, as recently highlighted as future directions for the framework [20, 53]. Use of the RE-AIM/PRISM framework was ideal for this pilot exploration with clinicians at this stage of program development. RE-AIM domains framed a broad inquiry of program implementation features while PRISM guided consideration of the fit and interactions among RE-AIM domains, intervention components and implementation strategies. Data can be challenging to obtain and assess across all domains [22]. Consistent with recommendations by RE-AIM/PRISM developers, we therefore sought to achieve “buy in and operationalization of the dimensions (domains) that (would) hold (our consensus of immediately relevant) value for stakeholders” and to “understand individual impacts and contextual implications” for planning adaptations [20, 53]. In the future, we will do more to address maintenance of the learned approaches. We will also address gaps between priorities and progress during implementation using a structured, iterative process, using iterative RE-AIM [46] or other frameworks to identify and document more local context-specific adaptations, such as ADAPT [54, 55].

There are limitations to this study. Although most interviewed stakeholders served urban and rural underserved communities, they were white and primarily physicians; while this distribution is consistent with the limited diversity of primary care clinicians practicing in Wisconsin [56], a more racially and ethnically diverse sample and including more advanced practice providers may have provided additional insights to needed program adaptations. For this study, we spoke with all program Champions and several Novices from the previous memory clinic pilot and spoke with only a few Novices from clinic settings without a memory clinic directly onsite. In the future, we will seek insights for adaptations in even more varied non-memory clinic primary care clinicians and settings and also seek input from persons living with dementia receiving care for BPSD and their care partners. Future steps will also include reviewing summary results with participants for member checking.

Conclusion

We discuss a novel approach to adapting the academic detailing model for improving clinician management of BPSD in persons with dementia. A qualitative application of the RE-AIM/PRISM framework with stakeholders having mixed experience with the program and care management for persons living with dementia was used to inform adaptations pre-implementation. This approach has been used to identify potential barriers and facilitators to reach, adoption, implementation, and effectiveness of this academic detailing model for delivery with family medicine and internal medicine primary care clinicians outside a memory clinic practice. Findings from this approach will be used to develop an implementation plan for a future cluster randomized controlled trial to measure the effectiveness of this intervention to improve health outcomes for persons living with dementia and BPSD and their care partners.

Abbreviations

BPSD

Behavioral and psychological symptoms of dementia

DICE Approach^TM

Describe, Investigate, Create, Evaluate

RE-AIM Framework

Reach, Effectiveness, Adoption, Implementation, Maintenance

PRISM

Practical, Robust, Implementation and Sustainability Model

Authors’ contributions

All listed authors made a substantial and direct contribution to the work: conceptualization, AW, TJL, MS, TA; methodology, AW, TJL, MS, TA; data collection, MS, JS; data analysis, TJL, MS, UP, JS, TA; writing—original draft preparation, TJL.; writing—review and editing, TJL, MS, UP, JS, TA, SH, SC, CMC, AW; and funding acquisition, AW, CMC. All authors have read and agreed to the published version of the manuscript.

Funding

This project was made possible with pilot funding through the University of Wisconsin-Madison Institute for Clinical and Translational Research, with support from the NIH-NCATS Clinical and Translational Science Award 1UL1TR002373, and through a grant of the Wisconsin Partnership Program (WPP 5129) at the University of Wisconsin School of Medicine and Public Health. The Wisconsin Alzheimer’s Institute (WAI) at the University of Wisconsin School of Medicine and Public Health also supported the project. Funders had no role in data collection or interpretation. Funders also had no role in reporting, other than the Director of WAI who is a co-author and reviewed the final manuscript.

Data availability

The datasets generated and analyzed during the current study are not publicly available in order to protect study participant privacy. Summary data are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All human subjects provided informed consent. The protocol for the study was approved by the Institutional Review Board for the University of Wisconsin-Madison, including a waiver for providing written consent. Individuals instead provided verbal consent and documented their consent through an electronic survey.

Consent for publication

Not applicable.

Competing interests

AW receives book royalties from the American Psychiatric Association Publishing for Behavioral & Psychological Symptoms of Dementia, Late-Life Depression & Anxiety, and Substance Use in Older Adults. Competing interests were managed by reaching consensus for methods, results and reporting across the entire team. There are no other declarations of competing interest.