Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: Expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities.
Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: Expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities.
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DOI：
10.1080/08897077.2020.1787299
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发表时间：
2020
期刊：
影响因子：
3.5
通讯作者：
Hagedorn H
中科院分区：
文献类型：
--
作者：
Gordon AJ;Drexler K;Hawkins EJ;Burden J;Codell NK;Mhatre-Owens A;Dungan MT;Hagedorn H
美国面临着阿片类药物使用障碍（OUD），阿片类药物滥用和阿片类药物相关危害的上升。阿片类药物使用障碍（MOUD）的药物治疗-包括美沙酮，丁丙诺啡和纳洛酮-是OUD的金标准治疗。MOUD减少了非法阿片类药物的使用，死亡率，犯罪活动，医疗保健成本和高风险行为。退伍军人健康管理局（VHA）已经投资了几项国家倡议，以鼓励获得MOUD治疗。尽管做出了这些努力，到2017年，只有超过三分之一的被诊断患有OUD的退伍军人接受了MOUD。VHA OUD专科护理通常集中在全国的大医院，由于地理位置或患者选择，获得这种护理可能很困难。认识到迫切需要改善获得MOUD护理的机会，VHA于2018年春季启动了阿片类药物使用障碍阶梯式护理，培训培训师（SCOUTT）计划，以促进VHA非SUD护理环境中获得MOUD。SCOUTT倡议的主要目标是通过培训在这些环境中工作的提供者如何提供MOUD，并通过提供持续的学习协作来促进实施，从而增加VHA初级保健，心理健康和疼痛诊所的MOUD处方。来自VHA 18个区域网络的13个医疗保健提供者被邀请在每个网络的一个设施内实施SCOUTT倡议。我们描述了SCOUTT倡议的目标和初步活动，导致为期两天的国家SCOUTT倡议会议，来自VHA所有18个区域网络的246名与会者参加。我们还讨论了SCOUTT倡议的后续实施促进和评估计划。VHA SCOUTT倡议可以成为在大型、多样化的医疗保健系统中实施MOUD的示范战略。
The US is confronted with a rise in opioid use disorder (OUD), opioid misuse, and opioid-associated harms. Medication treatment for opioid use disorder (MOUD)—including methadone, buprenorphine and naltrexone—is the gold standard treatment for OUD. MOUD reduces illicit opioid use, mortality, criminal activity, healthcare costs, and high-risk behaviors. The Veterans Health Administration (VHA) has invested in several national initiatives to encourage access to MOUD treatment. Despite these efforts, by 2017, just over a third of all Veterans diagnosed with OUD received MOUD. VHA OUD specialty care is often concentrated in major hospitals throughout the nation and access to this care can be difficult due to geography or patient choice. Recognizing the urgent need to improve access to MOUD care, in the Spring of 2018, the VHA initiated the Stepped Care for Opioid Use Disorder, Train the Trainer (SCOUTT) Initiative to facilitate access to MOUD in VHA non-SUD care settings. The SCOUTT Initiative’s primary goal is to increase MOUD prescribing in VHA primary care, mental health, and pain clinics by training providers working in those settings on how to provide MOUD and to facilitate implementation by providing an ongoing learning collaborative. Thirteen healthcare providers from each of the 18 VHA regional networks across the VHA were invited to implement the SCOUTT Initiative within one facility in each network. We describe the goals and initial activities of the SCOUTT Initiative leading up to a two-day national SCOUTT Initiative conference attended by 246 participants from all 18 regional networks in the VHA. We also discuss subsequent implementation facilitation and evaluation plans for the SCOUTT Initiative. The VHA SCOUTT Initiative could be a model strategy to implement MOUD within large, diverse health care systems.
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