Expanding access to medications for opioid use disorder through locally-initiated implementation.
Expanding access to medications for opioid use disorder through locally-initiated implementation.
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DOI：
10.1186/s13722-022-00312-7
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发表时间：
2022-06-20
影响因子：
3.7
通讯作者：
Morasco, Benjamin J.
中科院分区：
文献类型：
--
作者：
Wyse, Jessica J.;Mackey, Katherine;Lovejoy, Travis, I;Kansagara, Devan;Tuepker, Anais;Gordon, Adam J.;Korthuis, P. Todd;Herreid-O'Neill, Anders;Williams, Beth;Morasco, Benjamin J.
尽管疗效已得到证实，但许多患者仍然无法获得阿片类药物使用障碍（MOUD）的药物治疗，在个人，诊所和系统层面存在障碍。一系列广泛的实施战略为扩大MOUD的使用提供了指导，其中大多数战略都围绕着外部促进的实践变革方法。虽然有效，但这些方法可能无法进入那些缺乏与外部团队合作所需资源的诊所和系统，这表明需要确定和描述内部开发和推广的变革过程。在实施研究综合框架（CFIR）的指导下，我们利用定性访谈和人种学观察来调查当地发起的过程的规划，设计和实施，以扩大在一个医疗保健系统内获得MOUD。所有研究文件均由一级编码员和二级审查员使用设计用于CFIR的码本进行编码。为了分析数据，我们回顾了由关键代码标记的文本，比较了这些文本摘录在文档之间和文档内部，并将发现组织成主题。确定的过程被映射到既定的实施科学结构和战略。与临床医生和管理人员（n = 9）和人种学观察规划会议（n = 3）的采访揭示了一个自我任命的本地团队如何开发，建立广泛的支持，并成功地实施了一个基于初级保健的丁丙诺啡诊所和电子咨询服务，以扩大整个医疗保健系统的患者对MOUD的访问。首先，国家和地方政策的变化，包括改变临床实践指南，关于阿片类药物处方的绩效工资激励措施，以及VA中央办公室的指示，增加了个别工作人员和管理人员对变革需求的认识，以及投入时间和资源的意愿。然后，一个自封的跨学科团队利用跨诊所会议和信息收集来确定适当且得到广泛支持的护理提供和护理咨询模式。最后，该小组通过将工作人员纳入规划过程和鼓励协作解决问题，增加了工作人员对这些变革工作的投资。这项研究揭示了当地团队如何开发和建立广泛的支持，以适应当地需求，并随着时间的推移为可持续发展做好准备的新的护理过程。在线版本包含补充材料，可通过10.1186/s13722-022-00312-7获得。
Despite demonstrated efficacy, medication treatment for opioid use disorder (MOUD) remain inaccessible to many patients, with barriers identified at the individual, clinic and system level. A wide array of implementation strategies have guided efforts to expand access to MOUD, with most centered around externally-facilitated approaches to practice change. While effective, such approaches may be inaccessible to those clinics and systems that lack the resources necessary to partner with an external team, suggesting a need to identify and describe change-processes that are internally developed and promoted. Guided by the Consolidated Framework for Implementation Research (CFIR), we utilized qualitative interviews and ethnographic observation to investigate the planning, design and implementation of a locally-initiated process to expand access to MOUD within one health care system. All study documents were coded by a primary coder and secondary reviewer using a codebook designed for use with the CFIR. To analyze data, we reviewed text tagged by key codes, compared these textual excerpts both across and within documents, and organized findings into themes. Processes identified were mapped to established implementation science constructs and strategies. Interviews with clinicians and administrators (n = 9) and ethnographic observation of planning meetings (n = 3) revealed how a self-appointed local team developed, established broad support for, and successfully implemented a Primary Care-based Buprenorphine Clinic and E-Consult Service to expand access to MOUD to patients across the health care system. First, national and local policy changes—including altered clinical practice guidelines, performance pay incentives regarding opioid prescribing, and a directive from VA Central Office increased individual staff and administrators’ perception of the need for change and willingness to invest time and resources. Then, a self-appointed interdisciplinary team utilized cross-clinic meetings and information gathering to identify appropriate, and widely supported, models of care delivery and care consultation. Finally, the team increased staff investment in these change efforts by bringing them into the planning process and encouraging collaborative problem solving. This study reveals how a local team developed and built widespread support for new processes of care that were tailored to local needs and well-positioned for sustainability over time. The online version contains supplementary material available at 10.1186/s13722-022-00312-7.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.7
作者：
Hagedorn, Hildi;Kenny, Marie;Harris, Alex H. S.
通讯作者：
Harris, Alex H. S.
DOI：
10.1007/s11414-018-9616-9
发表时间：
2019-04-01
影响因子：
1.9
作者：
Croff, Raina;Hoffman, Kim;Schmidt, Laura
通讯作者：
Schmidt, Laura
影响因子：
2.8
作者：
Connolly, Samantha L.;Sullivan, Jennifer L.;Bauer, Mark S.
通讯作者：
Bauer, Mark S.
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R