The Balance Between Serving the Community and the Reality of Treating Opioid Use Disorder in Rural Primary Care Practices

Holtrop, Jodi Summers; Mullen, Rebecca; Curcija, Kristen; Westfall, John M.; Zittleman, Linda

doi:10.1353/hpu.2022.0019

Cited by 5 publications

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“…Documenting these counterfactual experiences, such as the anticipated vs actual volume of patients seeking OUD care, may help to change the narrative around the feasibility of providing MOUD in PC. 7,9,[31][32][33] This study's findings also suggest a need to better address barriers that lead PC teams to feel burdened by MOUD. Although all of the clinicians believed that MOUD could be successfully delivered in PC settings, many also held negative attitudes about how MOUD increased their workload without other forms of workload relief.…”

Section: Discussionmentioning

confidence: 81%

“…While clinicians also expressed concerns about their capacity to absorb new patients, including those with OUD, most struggled to identify patients eligible for treatment, and some clinicians felt discouraged by the low yield. Documenting these counterfactual experiences, such as the anticipated vs actual volume of patients seeking OUD care, may help to change the narrative around the feasibility of providing MOUD in PC …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integrating Opioid Use Disorder Treatment Into Primary Care Settings

et al. 2023

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ImportanceMedication for opioid use disorder (MOUD) (eg, buprenorphine and naltrexone) can be offered in primary care, but barriers to implementation exist.ObjectiveTo evaluate an implementation intervention over 2 years to explore experiences and perspectives of multidisciplinary primary care (PC) teams initiating or expanding MOUD.Design, Setting, and ParticipantsThis survey-based and ethnographic qualitative study was conducted at 12 geographically and structurally diverse primary care clinics that enrolled in a hybrid effectiveness–implementation study from July 2020 to July 2022 and included PC teams (prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists). Survey data analysis was conducted from February to April 2022.ExposureImplementation intervention (external practice facilitation) to integrate OUD treatment alongside existing collaborative care for mental health services.MeasuresData included (1) quantitative surveys of primary care teams that were analyzed descriptively and triangulated with qualitative results and (2) qualitative field notes from ethnographic observation of clinic implementation meetings analyzed using rapid assessment methods.ResultsSixty-two primary care team members completed the survey (41 female individuals [66%]; 1 [2%] American Indian or Alaskan Native, 4 [7%] Asian, 5 [8%] Black or African American, 5 [8%] Hispanic or Latino, 1 [2%] Native Hawaiian or Other Pacific Islander, and 46 [4%] White individuals), of whom 37 (60%) were between age 25 and 44 years. An analysis of implementation meetings (n = 362) and survey data identified 4 themes describing multilevel factors associated with PC team provision of MOUD during implementation, with variation in their experience across clinics. Themes characterized challenges with clinical administrative logistics that limited the capacity to provide rapid access to care and patient engagement as well as clinician confidence to discuss aspects of MOUD care with patients. These challenges were associated with conflicting attitudes among PC teams toward expanding MOUD care.Conclusions and RelevanceThe results of this survey and qualitative study of PC team perspectives suggest that PC teams need flexibility in appointment scheduling and the capacity to effectively engage patients with OUD as well as ongoing training to maintain clinician confidence in the face of evolving opioid-related clinical issues. Future work should address structural challenges associated with workload burden and limited schedule flexibility that hinder MOUD expansion in PC settings.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Integrating Opioid Use Disorder Treatment Into Primary Care Settings

et al. 2023

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“…The evaluation uses a multiple-methods design to improve the quality and function of IC implementation and training using data-driven indicators of program success (Holtrop et al, 2022; Zittleman et al, 2022). This design: (a) gathers mixed-methods data to assess whether the RUISTP changes attitudes and skills of fellows and system leaders; (b) examines changes in behavioral health, SUD, and medical service utilization using retrospective and prospective data (electronic medical records; public data on treatment seeking); and (c) uses continuous quality improvement to ascertain key process and progress indicators to provide timely information and mitigation strategies for implementation barriers.…”

Section: Evaluation Modelmentioning

confidence: 99%

Advancing the behavioral health workforce: An innovative integrated care and substance use disorder training model to improve outcomes for people in medically underserved communities.

Lister¹,

Marcello²,

Lister³

et al. 2022

Families, Systems, & Health

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Introduction: It is critical that we strengthen the ability of the behavioral health workforce to better manage the complex behavioral and physical health needs of people in medically underserved areas. Despite the knowledge that integrated care (IC) models improve patient outcomes and experience, provider satisfaction, and health care costs, educational and experiential training in IC is limited, limiting workforce capacity to deliver this care. Method: Through the Health Resources and Services Administration-funded Rutgers University Integrated Substance Use Disorder Training Program (RUISTP), we partner with community-based primary care clinics to implement an interprofessional fellowship program for psychologists, social workers, physician assistants, and advanced practice nurses. The RUISTP simultaneously provides training and implements IC within these community-based systems. Our multiple-methods evaluation design examines data-driven indicators of feasibility, uptake, and program success during implementation and sustainability phases and assesses changes in organizational beliefs and practices, provider competencies, and service utilization throughout the project period. Results: This article describes the significance and innovation of (a) an IC training program, (b) an implementation plan for sustained change within systems of care, and (c) evaluative methodology to assess and improve IC and SUD service delivery and training. These data will be used to create a template for other academic and health care systems nationally. Discussion: It is the mission of this program to use an innovative training, implementation, and evaluation design to enhance IC and SUD services, bolster the behavioral health workforce trained to provide high-quality IC, and inform replications of this model in other geographic and clinical settings, particularly those in medically underserved communities.

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Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice‐involved individuals in rural Appalachia

Staton

Pike

Tillson

et al. 2023

Journal Community Psychology

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The purpose of this qualitative study is to assess facilitating factors and barriers for medications to treat opioid use disorder (MOUD) initiation among justice‐involved individuals in one rural Appalachian community, as well as how those factors may differ across the three types of Food and Drug Administration (FDA) approved medications. Qualitative interviews were conducted with rural justice‐involved individuals (N = 10) with a history of opioid use in the target community. Overall, participants demonstrated knowledge of the different types of MOUD and their pharmacological properties, but limited overall health literacy around opioid use disorder and MOUD treatment. Treatment access was hampered by transportation, time burdens, and costs. Findings call for research into improving health literacy education, training, and resources to decrease stigma and increase access to MOUD, particularly in light of the ongoing opioid crisis. State policies also need to increase access to all FDA medications among justice‐involved individuals, as well as supporting a care continuum from facility entry, release, and community re‐entry.

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The Balance Between Serving the Community and the Reality of Treating Opioid Use Disorder in Rural Primary Care Practices

Cited by 5 publications

References 0 publications

Integrating Opioid Use Disorder Treatment Into Primary Care Settings

Integrating Opioid Use Disorder Treatment Into Primary Care Settings

Advancing the behavioral health workforce: An innovative integrated care and substance use disorder training model to improve outcomes for people in medically underserved communities.

Facilitating factors and barriers for use of medications to treat opioid use disorder (MOUD) among justice‐involved individuals in rural Appalachia

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