Table 3.

Barriers to Implementation and Possible Solutions in Pilot and Full ePCTs

Level and type of barriers	Key modifiable barriers	Possible solutions in pilot and full ePCTs
Innovation level
	Premature implementation of dementia care practices	Use Readiness Assessment for Pragmatic Trials tool
Context level
Organizational level	High turnover rates impact facilities’ ability to implement and sustain dementia care programs	Embed training into new staff orientation to integrate in workflow for sustainability Embed intervention monitoring in ongoing supervision, provide case presentations at staff meetings
External healthcare system level	Healthcare system policies do not support interdisciplinary care planning and communication Productivity and reimbursement constraints Complexity of dementia care not recognized in reimbursement policies	Assess organizational readiness for change and/or adoption of new practices when selecting sites for implementation of dementia care programs Advocate for policy change Identify payment models to support staff training and ongoing use of dementia care program
Recipient level
Provider level	Limited availability of trained clinicians in dementia care Implementation takes time and resources, which are limited in busy clinical settings with full caseloads	Advocate for dementia care in health professional curricula Appoint clinical champions to facilitate on-site problem solving in dementia care Provide dementia care training for medical licensure or continuing education credit Use online training to facilitate learning and shorten staff training time
Person living with dementia/ caregiver level	Families have autonomy to refuse treatments or may not see value in an intervention or how it addresses what matters most to them	Consult with a person-led advisory board to inform implementation Include person living with dementia and care partner in identifying implementation processes Provide education, empowerment, and shared decision-making
Researcher level	Researchers studying the implementation of evidence-based dementia care practice may lack the networks of potential partners interested in adopting or changing care practices	Establish networks of healthcare and community partners Develop an infrastructure to collaborate across healthcare and community partners Market implementation research of innovative care as way to solve a facility/system problem

Abbreviation: ePCT, embedded pragmatic clinical trial.