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Clinical leaders and providers' perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs' facilities.
Hawkins, Eric J; Danner, Anissa N; Malte, Carol A; Blanchard, Brittany E; Williams, Emily C; Hagedorn, Hildi J; Gordon, Adam J; Drexler, Karen; Burden, Jennifer L; Knoeppel, Jennifer; Lott, Aline; Sayre, George G; Midboe, Amanda M; Saxon, Andrew J.
  • Hawkins EJ; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA. Eric.Hawkins@va.gov.
  • Danner AN; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA, 98108, USA. Eric.Hawkins@va.gov.
  • Malte CA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA. Eric.Hawkins@va.gov.
  • Blanchard BE; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
  • Williams EC; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA, 98108, USA.
  • Hagedorn HJ; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
  • Gordon AJ; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA, 98108, USA.
  • Drexler K; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
  • Burden JL; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
  • Knoeppel J; Department of Health Services, University of Washington, Seattle, WA, USA.
  • Lott A; HSR&D Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.
  • Sayre GG; Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
  • Midboe AM; HSR&D Center of Innovation: Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
  • Saxon AJ; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Addict Sci Clin Pract ; 16(1): 55, 2021 09 06.
Article in English | MEDLINE | ID: covidwho-1430481
ABSTRACT

BACKGROUND:

Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers' perceptions about MOUD over the first year of implementation.

METHODS:

Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach.

RESULTS:

Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents' ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time.

CONCLUSIONS:

Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers' and clinical leaders' perceptions of MOUD over time. Strategies that improve leaders' prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Buprenorphine / Opioid-Related Disorders Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Addict Sci Clin Pract Journal subject: Substance-Related Disorders Year: 2021 Document Type: Article Affiliation country: S13722-021-00263-5

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Buprenorphine / Opioid-Related Disorders Type of study: Cohort study / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Addict Sci Clin Pract Journal subject: Substance-Related Disorders Year: 2021 Document Type: Article Affiliation country: S13722-021-00263-5