Bout CM: “We were bought by a significant holding firm, and I get the perception they’re money-driven, despite the fact that plenty of staff listed below are not. We PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21081558 try and locate balance involving very good care for individuals and satisfying the bottom line in the similar time, but price may be an obstacle for CM here.” “It seems like a patient could abuse the [CM] program if they figured out how to… and some on the counselors might be concerned that it would generate competition amongst the individuals.” Clinic Executive as Laggard At one particular clinic, no implementation or pending adoption choices was reported. The clinic mainly served immigrants of a certain ethnic group, with sturdy executive commitment to delivering culturally-competent care to this population. A byproduct of this focus seemed to become limited familiarity of treatment practices like CM for which broader patient populations are typically involved in empirical validation. Upon recognizing that following federal and state regulations SIS3 web concerning access to take-home medicines represent a de facto CM application, employees voiced support for familiar practices but reticence toward more novel uses of CM: “It’s like that saying…`give a man a fish he’s only gonna eat as soon as. But for those who teach him to fish he can eat to get a lifetime.’ The financial incentives appear like `I’m just gonna give you a fish.’ But getting take-home doses is like `I’m gonna teach you tips on how to fish’.” “I assume that will be among the list of worst points an individual could ever do, mixing monetary incentives in with drug addiction. Personally, I’d stick with all the conventional way we do items since if I am just providing you material stuff for clean UAs, it really is like I am rewarding you rather than you rewarding your self.” At a last clinic, no CM implementation or imminent adoption decisions have been reported. The executive was rather integrated into its daily practices, but generally highlighted fiscal issues over problems regarding high-quality of care. Consequently, empirically-validated practices like CM appeared under-valued. Employees saw small utility inside the use of CM, even as applied to state and federal recommendations governing access to take-home medication doses. A rather powerful reluctance toward constructive reinforcement of clientele of any sort was a constant theme: “I do not think it really is a motivator of any sort with our clientele, to offer a voucher is just not a motivator at all. And [take-home doses] are of pretty minimal value also…I mean, the drug dealer will provide you with those.” “Any kind of financial incentive, they’re gonna come across a way to sell that. So I believe any rewards are most likely just enabling. Rather than all that, I’d push to view what they worth…you know, push for personal duty and how much do they value that.”NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptDiscussionAs implies of investigating influences of executive innovativeness on CM implementation by community OTPs, sixteen geographically-diverse U.S. clinics have been visited. At each go to, an ethnographic interviewing approach was employed with its executive director from whichInt J Drug Policy. Author manuscript; accessible in PMC 2014 July 01.Hartzler and RabunPageimpressions have been later applied for classification into among 5 adopter categories noted in Rogers’ (2003) diffusion theory. The executive, at the same time as a clinical supervisor and two clinicians, also participated in person semi-structured interviews wherein they described training/exposure to CM and commented on clinic att.