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
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
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DOI：
10.1186/s13722-018-0127-z
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发表时间：
2018-12-13
影响因子：
3.7
通讯作者：
Harris, Alex H. S.
中科院分区：
文献类型：
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作者：
Hagedorn, Hildi;Kenny, Marie;Harris, Alex H. S.
背景：在美国，与处方阿片类药物有关的急诊室就诊和过量使用激增，包括海洛因和芬太尼在内的非法阿片类药物使用率正在上升。阿片类药物使用障碍(OUD)与较高的发病率和死亡率、较高的艾滋病毒和丙型肝炎感染率以及犯罪行为有关。阿片类激动剂治疗(燕麦片、美沙酮和丁丙诺啡)已被证明在治疗OUD和减少其负面后果方面有效。虽然OAT的疗效已经确定，但由于患者、提供者或系统因素，太少的提供者给OUD患者开OAT处方。虽然退伍军人健康管理局(VHA)在实施OAT方面取得了长足的进步，但国民治疗率仍然很低(OUD患者的比例为35%)，几个机构的开药率仍然很低。方法：从35个低开药点中随机选择8个基线开药率较低的退伍军人健康机构(VHA)，接受强化的外部便利化实施干预，以提高OAT的开药率。干预措施包括特定地点的发展评估、启动现场访问和12个月的持续促进。发展性评估包括对患者、物质使用障碍诊所工作人员以及初级保健和一般精神卫生领导的定性访谈，以评估现场层面的障碍。现场访问包括：(1)审查特定地点的障碍和潜在的实施战略；(2)指导如何使用现有的仪表板来跟踪处方比率和确定可采取行动的患者；以及(3)关于OAT的教育，如有要求，包括对处方医生进行丁丙诺啡认证培训。正在进行的促进工作包括每月与个别现场团队举行电话会议和专家临床咨询。主要结果是退伍军人发起和维持OAT的比例，与对照地点相比，干预地点预计处方增加更多。最后的定性访谈和成本评估将为未来的实施工作提供信息。讨论：该项目将检查并应对低处方VHA诊所遇到的障碍，允许改进干预措施，以提高OUD在额外设施中获得药物治疗的机会。
Background: In the US, emergency room visits and overdoses related to prescription opioids have soared and the rates of illicit opioid use, including heroin and fentanyl, are increasing. Opioid use disorder (OUD) is associated with higher morbidity and mortality, higher HIV and HCV infection rates, and criminal behavior. Opioid agonist therapy (OAT; methadone and buprenorphine) is proven to be effective in treating OUD and decreasing its negative consequences. While the efficacy of OAT has been established, too few providers prescribe OAT to patients with OUD due to patient, provider, or system factors. While the Veterans Health Administration (VHA) has made great strides in OAT implementation, national treatment rates remain low (35% of patients with OUD) and several facilities continue to have much lower prescribing rates.Methods: Eight VA sites with low baseline prescribing rates (lowest quartile, < 21%) were randomly selected from the 35 low prescribing sites to receive an intensive external facilitation implementation intervention to increase OAT prescribing rates. The intervention includes a site-specific developmental evaluation, a kick-off site visit, and 12 months of ongoing facilitation. The developmental evaluation includes qualitative interviews with patients, substance use disorders clinic staff, and primary care and general mental health leadership to assess site-level barriers. The site visit includes: (1) a review of site-specific barriers and potential implementation strategies; (2) instruction on using available dashboards to track prescribing rates and identify actionable patients; and (3) education on OAT, including, if requested, buprenorphine certification training for prescribers. On-going facilitation consists of monthly conference calls with individual site teams and expert clinical consultation. The primary outcomes is the proportion of Veterans with OUD initiating and sustaining OAT, with intervention sites expected to have larger increases in prescribing compared to control sites. Final qualitative interviews and a cost assessment will inform future implementation efforts.Discussion: This project will examine and respond to barriers encountered in low prescribing VHA clinics allowing refinement of an intervention to enhance access to medication treatment for OUD in additional facilities.