Table 5.

Developmental Formative Evaluation: The Example of Pharmacotherapy for Alcohol Use Disorders (Section VI.B)

Key Barriers Identified (Exemplar Quote)	Resulting Implementation Refinements
Lack of time: “I don’t have time for this. Patients are not coming in asking to address their alcohol use. I’d be lucky to have 5 min to discuss this.”	• Condense educational materials.
	• Make materials available through link in computerized record provider will already have open.
	• Present research demonstrating that brief conversations can reduce patient drinking levels.
Do not perceive current system as problematic: “The system works fine as it is. We have great substance use disorder folks to refer them to.”	• Data to demonstrate that majority of patients do not follow through on referrals.
	• Education on patient perspective: Patients that are not comfortable going to “addiction” or “mental health” clinic may address alcohol use as part of overall plan for improving health.
Perceived lack of patient interest: “Patients are not going to be happy with me if I bring this up. They don’t want to talk about it.”	• Present patient interview results: Patients want more information and would accept this information from their primary care provider.
Lack of proficiency: “I was never trained to deal with addictions. This is not in my purview.”	• Comprehensive education and consultation from peer specialists.
	• Stress impact of alcohol use on major diseases that they struggle to manage on a daily basis.