Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial

Abstract

BackgroundOverdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations’ efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to concerns regarding reimbursement. Throughout the USA, the prevalence of OUD far exceeds the capacity of the OUD pharmacotherapy treatment system. Poor access to OUD pharmacotherapy prescribers has become a workforce development need for the addiction treatment field and a significant health issue.MethodsThis cluster randomized controlled trial (RCT) is designed to increase buprenorphine and extended-release naltrexone treatment capacity for OUD. The implementation intervention to be tested is a bundle of OUD pharmacotherapy capacity building practices called the Prescriber Recruitment Bundle (PRB), which was developed and piloted in a previous statewide buprenorphine implementation study. For this cluster RCT, organizational sites will be recruited and then randomized into one of two arms: (1) control, with treatment as usual and access to a website with PRB resources, or (2) intervention, with organizations implementing the PRB using the Network for the Improvement of Addiction Treatment organizational change model over a 24-month intervention period and a 10-month sustainability period. The primary treatment outcomes for each organizational site are self-reported monthly counts of buprenorphine slots, extended-release naltrexone capacity, number of buprenorphine patients, and number of extended-release naltrexone patients.This trial will be conducted in Florida, Ohio, and Wisconsin, resulting in 35 sites in each arm, for a total sample size of 70 organizations.DiscussionThis study addresses three issues of substantial public health significance: (1) the pressing opioid misuse epidemic, (2) the low uptake of OUD treatment pharmacotherapies, and (3) the need to increase prescriber participation in the addiction treatment workforce.Trial registrationClinicalTrials.gov NCT02926482,

It's not just the money: The role of treatment ideology in publicly funded substance use disorder treatment

“…Leaders of organizations indicated that traditional trainings do not address provider and clinician discomfort with MOUD. Detailing and learning collaboratives are promising strategies (Molfenter et al, 2017) to increase familiarity and comfort with clinical practice and regulations.…”

Physicians’ satisfaction with providing buprenorphine treatment

“…As part of a cluster randomized clinical trial (RCT) focused on expanding access to medication for OUD (NCT02926482), 38 organizations in Florida, Ohio, and Wisconsin that were interested in expanding medication treatment were recruited for a 24-month study comparing two sets of implementation strategies [30]. The 38 organizations participating in the trial included 73 unique clinical sites.…”

Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine

“…255 Gaps exist in how rural and urban EM differ and it is important to further understand this topic, including the future of regional care access and effects of population migration. 161,[262][263][264][265][266][267][268] As more rural centers are closed and centralized metropolitan areas stretch their health care resources, there may be a greater need for trained EM telehealth providers. 29,74,262,265,266,269 During the consensus conference days, discussion included recommendations to broaden initial research questions to include a wider variety of health care providers in EM, including EMS, APPs, telepresenters, administrative teams, family members, and care partners.…”

“…161,[262][263][264][265][266][267][268] As more rural centers are closed and centralized metropolitan areas stretch their health care resources, there may be a greater need for trained EM telehealth providers. 29,74,262,265,266,269 During the consensus conference days, discussion included recommendations to broaden initial research questions to include a wider variety of health care providers in EM, including EMS, APPs, telepresenters, administrative teams, family members, and care partners. While another breakout group focused on education, the use of family and care partners in telehealth may require new instruction and assessments telehealth and health care in the future.…”