Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities

Hagedorn, Hildi; Kenny, Marie E.; Gordon, Adam J.; Ackland, Princess E.; Noorbaloochi, Siamak; Yu, Wei; Harris, Alex H. S.

doi:10.1186/s13722-018-0127-z

Cited by 43 publications

(51 citation statements)

References 26 publications

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“…The 12-month Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD) intervention is described elsewhere [ 28 ]. Briefly, for this mixed methods study, we conducted a qualitative, developmental formative evaluation of providers and leadership at low-adopting VHA facilities using semi-structured interviews prior to the intensive external facilitation intervention to identify barriers and facilitators to implementation of M-OUD.…”

Section: Methodsmentioning

confidence: 99%

“…We sought to determine whether employing a 12-month intensive external facilitation intervention enhances implementation of M-OUD at low-adopting VHA facilities [ 28 ]. This study focused primarily on implementation of buprenorphine due to the lower regulatory burden of prescribing buprenorphine compared to methadone and the higher level of evidence for effectiveness compared to naltrexone.…”

Section: Introductionmentioning

confidence: 99%

“…The project will also encourage implementation of injectable naltrexone for cases where buprenorphine is not a viable or acceptable alternative for a particular patient. The Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD) study engaged stakeholders across multiple clinic setting within the facility (e.g., primary care, mental health, pain specialty clinic, substance use disorder specialty clinic) and included an on-site visit with the research team, active goal setting, education, M-OUD training, and monthly facilitation calls [ 28 ]. The study is based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, which hypothesizes that implementation success of a clinical innovation is driven by active facilitation with recipients (e.g., providers, leaders, patients) in their context (e.g., clinical setting) [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

“…Facilitation began with a site visit where the facilitators and individuals at the local facilities worked together to develop an action plan that could be executed rapidly to address barriers and leverage facilitators. Following the site visit, facilitators worked collaboratively with each site on their goals over the course of 1 year [ 28 ]. The purpose of this mixed methods study is to (1) categorize pre-implementation barriers and facilitators through use of qualitative inquiry with key stakeholders at intervention facilities, (2) describe the strategies employed during the first 6 months of intensive external facilitation, and (3) explore patterns of barriers and facilitators identified pre-implementation in the context of 6-month quantitative outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Early impacts of a multi-faceted implementation strategy to increase use of medication treatments for opioid use disorder in the Veterans Health Administration

Gustavson

Wisdom

Kenny

et al. 2021

Implement Sci Commun

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Background Despite the risk of negative sequelae from opioid use disorder (OUD) and clinical guidelines for the use of effective medication treatment for OUD (M-OUD), many Veterans Health Administration (VHA) providers and facilities lag in providing M-OUD. An intensive external facilitation intervention may enhance uptake in low-adopting VHA facilities by engaging stakeholders from multiple clinical settings within a facility (e.g., mental health, primary care, pain specialty clinic, substance use disorder clinics). Our study identified pre-intervention determinants of implementation through qualitative interviews, described strategies employed during the first 6 months of intensive external facilitation, and explored patterns of implementation determinants in relation to early outcomes. Methods Guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we interviewed stakeholders at low-adopting VHA facilities prior to external facilitation, employed a rapid qualitative analytic process, presented findings during facility visits, and collaboratively created facilitation action plans to achieve goals set by the facilities that would increase M-OUD uptake. The primary outcome was the Substance Use Disorder (SUD)-16, which is a VHA facility-level performance metric consisting of the percent of patients receiving M-OUD among those with an OUD diagnosis. We examined the relationship between pre-implementation factors and 6-month SUD-16 outcomes. Results Across eight VHA facilities, we interviewed 68 participants. Implementation determinants included barriers and facilitators across innovation, context, and recipients constructs of i-PARIHS. Each facility selected goals based on the qualitative results. At 6 months, two facilities achieved most goals and two facilities demonstrated progress. The SUD-16 from baseline to 6 months significantly improved in two facilities (8.4% increase (95 % confidence interval [CI] 4.4–12.4) and 9.9% increase (95% CI 3.6–16.2), respectively). Six-month implementation outcomes showed that the extent to which M-OUD aligns with existing clinical practices and values was a primary factor at all facilities, with six of eight facilities perceiving it as both a barrier and facilitator. External health system barriers were most challenging for facilities with the smallest change in SUD-16. Conclusions Early impacts of a multi-faceted implementation approach demonstrated a strong signal for positively impacting M-OUD prescribing in low-adopting VHA facilities. This signal indicates that external facilitation can influence adoption of M-OUD at the facility level in the early implementation phase. These short-term wins experienced by stakeholders may encourage continued adoption and long-term sustainability M-OUD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early impacts of a multi-faceted implementation strategy to increase use of medication treatments for opioid use disorder in the Veterans Health Administration

Gustavson

Wisdom

Kenny

et al. 2021

Implement Sci Commun

Self Cite

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“…3,4 which remain the two most popular pharmacological interventions to treat OUD in the United States. 5,6 Opioid agonist therapy is widely regarded as among the most effective methods of treating opioid use disorders (OUD) particularly when paired with behavioral substance use interventions. 3,4,7 A wealth of prior literature emphasizes the benefits of buprenorphine and methadone to reduce relapse, drug use, fatal and non-fatal overdose, injection drug behaviors as well as increase antiretroviral therapy (ART) adherence, HIV viral suppression and decrease recidivism and hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Assessing factors associated with discharge from opioid agonist therapy due to incarceration in the United States

Marotta

Stringer

Mandavia

et al. 2019

Journal of Addictive Diseases

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The following study investigates factors associated with discharge from OAT due to incarceration in a sample of 64,331 discharges in the United States. Multinomial regression investigated the association between demographic factors, prior arrest, referral source (i.e criminal justice agency) intravenous drug use, types of drug used, length of prior treatment and discharge due to incarceration compared to completing treatment or discharge due to other reasons. African Americans, Latinx, and Native Americans were at greater risk of discharge due to incarceration compared to whites. Referral to OAT from criminal justice agencies and self-referral was associated with increased risk of discharge from OAT due to incarceration compared to referral from a health care provider. Substance use of heroin, benzodiazepines, synthetic opioids, cocaine and non-prescription use of methadone were associated with discharge due to incarceration. Risk of discharge due to incarceration was higher for patients who reported intravenous drug use and who reported a co-morbid psychiatric problem. These findings enrich a nascent body of literature on mechanisms associated with attrition from OAT due to incarceration and emphasize the need for programs to divert people with OUD from incarceration to increase engagement and retention in OAT.

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Scaling Beyond Early Adopters: a Content Analysis of Literature and Key Informant Perspectives

et al. 2020

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Background Innovations and improvements in care delivery are often not spread across all settings that would benefit from their uptake. Scale-up and spread efforts are deliberate efforts to increase the impact of innovations successfully tested in pilot projects so as to benefit more people. The final stages of scale-up and spread initiatives must contend with reaching hard-to-engage sites. Objective To describe the process of scale-up and spread initiatives, with a focus on hard-to-engage sites and strategies to approach them. Design Qualitative content analysis of systematically identified literature and key informant interviews. Participants Leads from large magnitude scale-up and spread projects. Approach We conducted a systematic literature search on large magnitude scale-up and spread and interviews with eight project leads, who shared their perspectives on strategies to scale-up and spread clinical and administrative practices across healthcare systems, focusing on hard-to-engage sites. We synthesized these data using content analysis. Key Results Searches identified 1919 titles, of which 52 articles were included. Thirty-four discussed general scale-up and spread strategies, 11 described hard-to-engage sites, and 7 discussed strategies for hard-to-engage sites. These included publications were combined with interview findings to describe a fourth phase of the national scale-up and spread process, common challenges for spreading to hard-to-engage sites, and potential benefits of working with hard-to-engage sites, as well as useful strategies for working with hard-to-engage sites. Conclusions We identified scant published evidence that describes strategies for reaching hard-to-engage sites. The sparse data we identified aligned with key informant accounts. Future work could focus on better documentation of the later stages of spread efforts, including specific tailoring of approaches and strategies used with hard-to-engage sites. Spread efforts should include a “flexible, tailored approach” for this highly variable group, especially as implementation science is looking to expand its impact in routine care settings.

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Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities

Cited by 43 publications

References 26 publications

Early impacts of a multi-faceted implementation strategy to increase use of medication treatments for opioid use disorder in the Veterans Health Administration

Early impacts of a multi-faceted implementation strategy to increase use of medication treatments for opioid use disorder in the Veterans Health Administration

Assessing factors associated with discharge from opioid agonist therapy due to incarceration in the United States

Scaling Beyond Early Adopters: a Content Analysis of Literature and Key Informant Perspectives

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