Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD): an Implementation Trial in Eight Veterans Health Administration Facilities.
Advancing Pharmacological Treatments for Opioid Use Disorder (ADaPT-OUD): an Implementation Trial in Eight Veterans Health Administration Facilities.
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DOI：
10.1007/s11606-021-07274-7
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发表时间：
2022-11
影响因子：
5.7
通讯作者：
Gordon AJ
中科院分区：
文献类型：
--
作者：
Hagedorn HJ;Gustavson AM;Ackland PE;Bangerter A;Bounthavong M;Clothier B;Harris AHS;Kenny ME;Noorbaloochi S;Salameh HA;Gordon AJ
确定有效的战略，以改善阿片类药物使用障碍（MOUD）的药物治疗是当务之急。在退伍军人健康管理局（VHA）内，MOUD的提供差异很大，需要制定和测试针对MOUD提供率低的设施的实施策略。确定与匹配对照相比，在MOUD基线提供较低的VHA机构中增加MOUD提供的外部促进的有效性。一项前后、区组随机研究，旨在比较合格机构分层样本中的机构水平结局。通过接受MOUD的OUD患者比例和目前未接受MOUD的OUD患者数量的中位数划分定义了四个区（每个区有两个干预设施）（即，可操作的患者数量）。干预设施参加了为期12个月的实施干预。VHA设施在MOUD提供的最低四分位数（35个设施），其中8个被随机分配参与干预（每个街区2个）与27个街区作为匹配的对照。外部促进包括评估当地障碍/促进者、组建当地执行小组、实地考察行动规划和培训/教育、跨设施季度电话会议、每月辅导电话会议和咨询。与对照机构相比，接受MOUD的OUD诊断患者的机构水平比率的前后变化。干预设施显著增加了OUD患者接受MOUD的比例，从基线时的平均18%增加到1年后的30%，绝对差异为12%（95%置信区间[CI]：6.6%，17.0%）。干预和控制设施之间的差异为3.0%（95%CI：-0.2%）。6.7%）。干预的影响因街区而异，较小，不太复杂的设施更有可能优于匹配的控制。密集的外部促进改善了大多数低绩效设施对MOUD的采用，并可能超越其他不太适合个别设施环境的干预措施。
Identifying effective strategies to improve access to medication treatments for opioid use disorder (MOUD) is imperative. Within the Veterans Health Administration (VHA), provision of MOUD varies significantly, requiring development and testing of implementation strategies that target facilities with low provision of MOUD. Determine the effectiveness of external facilitation in increasing the provision of MOUD among VHA facilities with low baseline provision of MOUD compared to matched controls. Pre-post, block randomized study designed to compare facility-level outcomes in a stratified sample of eligible facilities. Four blocks (two intervention facilities in each) were defined by median splits of both the ratio of patients with OUD receiving MOUD and number of patients with OUD not currently receiving MOUD (i.e., number of actionable patients). Intervention facilities participated in a 12-month implementation intervention. VHA facilities in the lowest quartile of MOUD provision (35 facilities), eight of which were randomly assigned to participate in the intervention (two per block) with twenty-seven serving as matched controls by block. External facilitation included assessment of local barriers/facilitators, formation of a local implementation team, a site visit for action planning and training/education, cross-facility quarterly calls, monthly coaching calls, and consultation. Pre- to post-change in the facility-level ratio of patients with an OUD diagnosis receiving MOUD compared to control facilities. Intervention facilities significantly increased the ratio of patients with OUD receiving MOUD from an average of 18% at baseline to 30% 1 year later, with an absolute difference of 12% (95% confidence interval [CI]: 6.6%, 17.0%). The difference in differences between intervention and control facilities was 3.0% (95% CI: − 0.2%. 6.7%). The impact of the intervention varied by block, with smaller, less complex facilities more likely to outperform matched controls. Intensive external facilitation improved the adoption of MOUD in most low-performing facilities and may enhance adoption beyond other interventions less tailored to individual facility contexts.
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