Maintaining prevention in practice - Survival of PPIP in primary care settings

Introduction: Put Prevention Into Practice (PPIP) consists of a kit of offi ce-based tools intended to support the provision of preventive services by primary care providers. The purpose of this study was to examine the instit utionalization of PPIP within five primary care clinics funded by the Texas Department of Health to implement PPIP, and to examine the organizational determinants of program institutionalization. Methods: We utilized an adaptation of the Level of Institutionalizaton (LoI n) scales for qualitative data collection and for development of an institu tionalization score for each site. The determinants of institutionalization were derived from the organizational behavior and health promotion literat ures and used as categories for analysis. In addition, for purposes of tria ngulation, chart audit data for three documentation behaviors were also col lected. Results: PPIP has been maintained-at varying degrees of integration-in four of the five sites studied. for 6 years after adoption. Organizational fact ors that facilitated the institutionalization process were the site's insti tutional strength, the integration of PIPP within extant programs and servi ces, visibility of the program within and outside the site, planning for th e termination of grant funding, and presence of a program champion with mid - to upper-level managerial authority. Successful initiation of the program was not a predictor of institutionalization outcomes. Conclusions: We have highlighted the need to consider organizational determ inants of institutionalization in relation to their specific sociopolitical contexts, and in relation to each other, not in isolation.