Expanding access to medications for opioid use disorder in primary care clinics: an evaluation of common implementation strategies and outcomes

Author:

Cheng HannahORCID,McGovern Mark P.,Garneau Hélène Chokron,Hurley Brian,Fisher Tammy,Copeland Meaghan,Almirall Daniel

Abstract

Abstract Background To combat the opioid epidemic in the USA, unprecedented federal funding has been directed to states and territories to expand access to prevention, overdose rescue, and medications for opioid use disorder (MOUD). Similar to other states, California rapidly allocated these funds to increase reach and adoption of MOUD in safety-net, primary care settings such as Federally Qualified Health Centers. Typical of current real-world implementation endeavors, a package of four implementation strategies was offered to all clinics. The present study examines (i) the pre-post effect of the package of strategies, (ii) whether/how this effect differed between new (start-up) versus more established (scale-up) MOUD practices, and (iii) the effect of clinic engagement with each of the four implementation strategies. Methods Forty-one primary care clinics were offered access to four implementation strategies: (1) Enhanced Monitoring and Feedback, (2) Learning Collaboratives, (3) External Facilitation, and (4) Didactic Webinars. Using linear mixed effects models, RE-AIM guided outcomes of reach, adoption, and implementation quality were assessed at baseline and at 9 months follow-up. Results Of the 41 clinics, 25 (61%) were at MOUD start-up and 16 (39%) were at scale-up phases. Pre-post difference was observed for the primary outcome of percent of patient prescribed MOUD (reach) (βtime = 3.99; 0.73 to 7.26; p = 0.02). The largest magnitude of change occurred in implementation quality (ES = 0.68; 95% CI = 0.66 to 0.70). Baseline MOUD capability moderated the change in reach (start-ups 22.60%, 95% CI = 16.05 to 29.15; scale-ups −4.63%, 95% CI = −7.87 to −1.38). Improvement in adoption and implementation quality were moderately associated with early prescriber engagement in Learning Collaboratives (adoption: ES = 0.61; 95% CI = 0.25 to 0.96; implementation quality: ES = 0.55; 95% CI = 0.41 to 0.69). Improvement in adoption was also associated with early prescriber engagement in Didactic Webinars (adoption: ES = 0.61; 95% CI = 0.20 to 1.05). Conclusions Rather than providing an all-clinics-get-all-components package of implementation strategies, these data suggest that it may be more efficient and effective to tailor the provision of implementation strategies based on the needs of clinic. Future implementation endeavors could benefit from (i) greater precision in the provision of implementation strategies based on contextual determinants, and (ii) the inclusion of strategies targeting engagement.

Funder

California Department of Health Care Services

National Institute on Drug Abuse

Publisher

Springer Science and Business Media LLC

Subject

General Medicine

Reference72 articles.

1. Center for Disease Control and Prevention. Understanding the epidemic. 2020 [cited 2020 Oct 10]. Available from: https://www.cdc.gov/drugoverdose/epidemic/index.html

2. Bilirakis M. H.R.4365 - 106th Congress (1999-2000): Children’s Health Act of 2000. 2000 [cited 2020 Mar 14]. Available from: https://www.congress.gov/bill/106th-congress/house-bill/4365

3. Murthy VH. Ending the opioid epidemic — a call to action. N Engl J Med. 2016;375(25):2413–5.

4. Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev. 2016;2016(5) Available from: www.cochranelibrary.com.

5. Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies — tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063–6.

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