Implementing group visits for opioid use disorder: A case series.

Background: Group-based models of Office-Based Opioid Treatment with buprenorphine-naloxone (B/N) are increasingly being implemented in clinical practice to increase access to care and provide additional therapeutic benefits. While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings. Case series: We present 4 cases of GBOT implementation across a large academic health care system, highlighting various potential approaches for providers who seek to implement GBOT and demonstrate "success" based on feasibility and sustainability of these models. For each case, we describe the pros and cons and detail the personnel and resources involved, patient mix and group format, workflow logistics, monitoring and management, and sustainability components. Discussion: The implementation details illustrate that there is no one-size-fits-all approach, although feasibility is commonly supported by a team-based, patient-centered medical home. This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system. Future research identifying the core and malleable components to implementation, their evidence base, and how they might be influenced by site-specific resources, culture, and other contextual factors can help providers better understand how to implement a GBOT model in their unique clinical environment.

Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study.

BACKGROUND: Primary care providers are well positioned to respond to the opioid crisis by providing buprenorphine/naloxone (B/N) through shared medical appointments (SMAs). Although quantitative research has been previously conducted on SMAs with B/N, the authors conducted a qualitative assessment from the patients' point of view, considering whether and how group visits provide value for patients. METHODS: Twenty-five participants with opioid use disorder (OUD) who were enrolled in a weekly B/N group visit at a family medicine clinic participated in either of two 1-hour-long focus groups, which were conducted as actual group visits. Participants were prompted with the question "How has this group changed you as a person?" Data were audio-recorded and professionally transcribed and analyzed using a qualitative thematic approach, identifying common communication behaviors and resulting attitudes about the value of the group visit model. RESULTS: Participants demonstrated several communication behaviors that support group members in their recovery, including offering direct emotional support to others struggling with difficult experiences, making an intentional effort to probe about others' lives, venting about heavy situations, joking to lighten the mood, and expressing feelings of gratitude to the entire group. These communication behaviors appear to act as mechanisms to foster a sense of accountability, a shared identity, and a supportive community. Other demonstrated group behaviors may detract from the value of the group experience, including side conversations, tangential comments, and individual participants disproportionately dominating group time. CONCLUSION: The group visit format for delivering B/N promotes group-specific communication behaviors that may add unique value in supporting patients in their recovery. Future research should elucidate whether these benefits can be isolated from those achieved solely through medication treatment with B/N and if similar benefits could be achieved in non-primary care sites.

Group-based treatment of opioid use disorder with buprenorphine: A systematic review.

BACKGROUND: Opioid use disorder (OUD) has become a public health crisis in the U.S., and there is a need to develop effective clinical treatment strategies. Coupling buprenorphine/naloxone (B/N) maintenance with counseling is encouraged as a best practice, yet the efficacy research on individual counseling in B/N-based Office-Based Opioid Treatment (OBOT) has been equivocal to date. In contrast, models for integrating B/N prescribing through group-based counseling could potentially have a differential impact, yet no systematic reviews have focused on examining the extent of the literature on group-based models of B/N delivery. METHODS: We conducted a systematic literature review to identify existing studies characterizing the different formats of Group-Based Opioid Treatment (GBOT), which we defined as the coupling of B/N prescribing with required office-based group counseling. Using this definition of GBOT, B/N prescribing could occur either concurrently during a medical visit with group counseling (i.e., Shared Medical Appointment) or asynchronously (i.e., Group Psychotherapy). We assessed for all available scientific literature reporting on the feasibility, acceptability and/or efficacy of these different forms of GBOT. The systematic review protocol used PRISMA standards. RESULTS: We included 10 peer-reviewed, full-text articles and 5 conference abstracts of office-based opioid use disorder treatment that reported data on the feasibility, acceptability, and efficacy of Group-Based Opioid Treatment with B/N. Of the ten full-text articles we included 4 studies describing a shared medical appointment (SMA) model and 6 studies describing a group psychotherapy model. Of these studies, all were low in quality due to study design and only three were randomized controlled trials. No studies were appropriately designed to rigorously compare the efficacy of a GBOT approach (i.e., B/N prescribing with required group-based counseling) versus B/N prescribing with required individual counseling; nor were they designed for rigorous comparison with medication management alone. Nevertheless, most studies reported on the feasibility and acceptability of various models representative of a GBOT approach. CONCLUSION: The small number of studies and study design limited the conclusions that could be drawn about the feasibility, acceptability, and efficacy of group-based B/N treatment. More research is needed to determine whether benefits exist of GBOT with B/N.