Research implementation practice and patient liaison (RIPPL) roles in a pragmatic trial of medications for opioid use disorder in practice-based research: The RIPPL effect
Bethany M. Kwan, Douglas Fernald, Linda Zittleman, Tristen Hall, Donald E. Nease, Benjamin Sofie, Cory LutgenAbstract
Introduction:
Pragmatic trials involve patient recruitment, intervention delivery, and data collection leveraging usual systems and processes of care. Yet pragmatic does not mean easy, such that enacting pragmatic trial protocols requires considerable effort to engage patients and practice members. Home versus Office versus Telehealth for Medication Enhanced Recovery (HOMER) was a national pragmatic trial testing comparative effectiveness of office, home-based, and telehealth induction of medications for opioid use disorder (MOUD). Research implementation practice and patient liaisons (RIPPLs) were employed to support pragmatic trial conduct across 100 participating practices nationwide. The objective of this paper is to report on RIPPL roles and impact.
Methods:
Fourteen RIPPLs were matched to practices based on geographic proximity, research network membership, and caseload. Study records, field notes, and a qualitative survey were used to describe RIPPL processes and experiences and to assess impact.
Results:
RIPPLs had backgrounds in research coordination, project management, primary care delivery support, and adult learning. RIPPL activities supported practice motivation, follow-through, and protocol fidelity, and included several elements of practice facilitation. RIPPLs provided real-time feedback to the research team on opportunities for research protocol adaptations. Impact of the RIPPLs included protocol adaptations to decrease practice burden and improve ease of patient participation, regular eligible criteria fidelity monitoring, data completeness, and quality, and educating clinicians and staff on MOUD delivery.
Discussion:
RIPPLs can effectively support pragmatic trial conduct in primary care. HOMER RIPPLs enabled the research protocol to be iteratively more pragmatic (both feasible and aligned with the primary care context) while maintaining rigor and fidelity of intervention implementation.