Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact.
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact.
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DOI：
10.1097/adm.0000000000000310
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发表时间：
2017
影响因子：
5.5
通讯作者：
Sigmon SC
中科院分区：
文献类型：
--
作者：
Brooklyn JR;Sigmon SC
阿片类药物使用障碍（OUD）在美国正达到流行病的比例，许多地理区域都在与阿片类药物激动剂治疗的持续短缺作斗争。在过去的5年里，佛蒙特州成瘾医学医生和公共卫生领导人通过开发一个综合的轴辐式阿片类药物治疗网络来应对这些挑战。在本报告中，我们回顾了这种新型的轴辐式模型的发展，实施和影响，以扩大在佛蒙特州的OUD治疗。佛蒙特州的中心辐射系统已在全州范围内实施，并受到供应商和患者的好评。采用这种模式与该州的OUD治疗能力的大幅增加有关，佛蒙特州现在拥有美国治疗OUD的最高能力，每1000人中有10.56人接受治疗。放弃开丁丙诺啡的医生增加了64%，每个放弃医生服务的患者增加了50%，并且根据临床需要在中心和辐条之间进行了强大的双向转移。系统实施的挑战和重要的未来方向进行了讨论。轴辐式护理系统的开发和实施为佛蒙特州阿片类激动剂治疗能力的提高做出了重大贡献。该系统可以作为其他国家应对当前阿片类药物使用流行病的模式。
Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network. In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont. Vermont’s hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state’s OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed. Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.