Table 1 Implementation facilitators and barriers, with resolution to barriers

Ease of system use

X

Perceived potential to affect care

X

Difficulty contacting the practice and lack of study champion

X

Each practice was requested to identify two staff members to serve as implementation coordinators to be the primary contacts for the practice and would work with our study personnel

Lack of training and registration difficulties

X

• Created a proactive helpdesk to enhance our study personnel’s availability for technical assistance.

• Provide training to implementation coordinators in the referral intervention and act as trainers for other staff

• Supported the referral process throughout the six months.

Lack of motivation and start-up incentives

X

Increased both extrinsic (E) and intrinsic (I) motivation

• Financial incentive for participation in initial training session (E)

• Motivational interviewing into each interaction (I)

Forgetting to refer

X

• Called implementation coordinators to aid them in the registration process and answer questions

• Training calls included experiential hands-on practice with referrals (using simulated “test” patients).

• Increased work-flow support (see helpdesk)

• Included the printed information prescription pads to use simultaneously with online referral

• Developed posters to serve as visual stimulation to use the system and to encourage patients to talk with their provider about quitting

• Provided a 1-page instruction sheet outlining the steps for referring patients were sent to practices