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Expanding access to medications for opioid use disorder through locally-initiated implementation.
Wyse, Jessica J; Mackey, Katherine; Lovejoy, Travis I; Kansagara, Devan; Tuepker, Anais; Gordon, Adam J; Todd Korthuis, P; Herreid-O'Neill, Anders; Williams, Beth; Morasco, Benjamin J.
Afiliação
  • Wyse JJ; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA. Jessica.Wyse@va.gov.
  • Mackey K; School of Public Health, Oregon Health & Science University-Portland State University, 1810 SW 5th Avenue, Portland, OR, 97201, USA. Jessica.Wyse@va.gov.
  • Lovejoy TI; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA.
  • Kansagara D; Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
  • Tuepker A; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA.
  • Gordon AJ; School of Public Health, Oregon Health & Science University-Portland State University, 1810 SW 5th Avenue, Portland, OR, 97201, USA.
  • Todd Korthuis P; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
  • Herreid-O'Neill A; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA.
  • Williams B; Department of General Internal Medicine & Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
  • Morasco BJ; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd., Portland, OR, 97239, USA.
Addict Sci Clin Pract ; 17(1): 32, 2022 06 20.
Article em En | MEDLINE | ID: mdl-35725648
ABSTRACT

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Analgésicos Opioides / Transtornos Relacionados ao Uso de Opioides Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Analgésicos Opioides / Transtornos Relacionados ao Uso de Opioides Idioma: En Ano de publicação: 2022 Tipo de documento: Article