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.
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DOI：
10.1186/s43058-021-00119-8
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发表时间：
2021-02-15
影响因子：
--
通讯作者：
Hagedorn HJ
中科院分区：
文献类型：
--
作者：
Gustavson AM;Wisdom JP;Kenny ME;Salameh HA;Ackland PE;Clothier B;Noorbaloochi S;Gordon AJ;Hagedorn HJ
尽管阿片类药物使用障碍（OUD）和使用有效药物治疗OUD（M-OUD）的临床指南存在负面后遗症的风险，但许多退伍军人健康管理局（VHA）提供者和设施在提供M-OUD方面落后。强化的外部促进干预可以通过吸引来自设施内多个临床环境的利益相关者（例如，精神健康、初级保健、疼痛专科诊所、物质使用障碍诊所）。我们的研究通过定性访谈确定了实施干预前的决定因素，描述了在前6个月的密集外部促进的策略，并探讨了与早期结果有关的实施决定因素的模式。在卫生服务研究实施综合促进行动（i-PARIHS）框架的指导下，我们在外部促进之前采访了低采用VHA设施的利益相关者，采用了快速定性分析过程，在设施访问期间提出了调查结果，并协同创建促进行动计划，以实现设施设定的目标，增加M-OUD的吸收。主要结局是物质使用障碍（SUD）-16，这是一个VHA机构级性能指标，包括OUD诊断患者中接受M-OUD的患者百分比。我们研究了实施前因素与6个月SUD-16结果之间的关系。在八个VHA设施中，我们采访了68名参与者。实施的决定因素包括跨创新的障碍和促进因素，上下文，和受援国的i-PARIHS结构。每个设施根据定性结果选择目标。在6个月时，两个设施实现了大多数目标，两个设施取得了进展。两个机构的SUD-16从基线至6个月显著改善（分别增加8.4%（95%置信区间[CI] 4.4-12.4）和9.9%（95% CI 3.6-16.2））。六个月的实施结果表明，M-OUD与现有临床实践和价值观的一致程度是所有设施的主要因素，八个设施中有六个将其视为障碍和促进因素。外部卫生系统障碍对SUD-16变化最小的设施最具挑战性。多方面实施方法的早期影响表明，在低采用VHA设施中，M-OUD处方具有积极影响的强烈信号。这一信号表明，外部促进可以影响采用M-OUD在设施一级的早期实施阶段。利益相关者经历的这些短期胜利可能会鼓励继续采用和长期可持续性M-OUD。在线版本包含补充材料，可通过10.1186/s43058-021-00119-8获得。
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. 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. 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. 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. The online version contains supplementary material available at 10.1186/s43058-021-00119-8.
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影响因子：
3.7
作者：
Hagedorn, Hildi;Kenny, Marie;Harris, Alex H. S.
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CANTOR, N