Key Lessons Learned in Medication-Assisted Treatment Implementation
- Provider Recruitment: While recruitment was anticipated to be a challenge, it has been more challenging and has taken longer than anticipated to identify and engage interested clinicians. Sometimes seeds laid with clinicians and practices about obtaining a waiver and using medication to treat patients with opioid use disorder (OUD) take months of exposure to take root and yield interest. Ongoing periodic follow-up with providers who express interest but experience delays in pursuing or obtaining the waiver ensures that support is waiting for the provider when they are ready to proceed.
- DEA Waivers: Federal regulations have opened the ability to obtain a waiver to a larger body of clinicians. However, parties who want to implement MAT need to understand State or local policies or requirements (e.g., exclusionary formularies, supervisory requirements for nurse practitioners or physician assistants). In some cases, these may present barriers to clinicians’ ability to prescribe medications for OUD.
- High Staff Turnover: The high amount of clinician turnover is a challenge to retaining qualified providers in practices that are already stretched thin.
- Engagement: Engagement is highly variable. Ongoing outreach/contact may be needed to ensure training is progressing and clinicians are moving toward treating patients.
- There are 49 active participants in the Oklahoma MAT project. Of these, 35 have completed training and 29 have obtained the waiver required to prescribe buprenorphine-based medications to treat patients with OUD. The project has also further supported the required waiver training for approximately 20 additional Oklahoma clinicians who are not Oklahoma MAT participants, but lived in proximity to in-person trainings sponsored by the project Oklahoma.
- Over 200 patients have received treatment for OUD as a result of PCP participation in this program.
- The Oklahoma MAT program has contributed to a 350% increase in the number of providers in our counties of focus who are waivered to treat OUD using buprenorphine-based medications. Although we are not the only initiative contributing to this increase, Oklahoma MAT providers account for about a third of the increase in waivered providers since the program began. In six of our counties of focus, an Oklahoma MAT provider is the only waivered provider in the county.
Conferences & Publications
- Heil SKR, Kilany M, Paez K, Cowans T, Johnson E. Preparing Primary Care Providers in Rural Oklahoma To Offer Medication Assisted Treatment for Opioid Use Disorder. AcademyHealth 2018 Annual Research Meeting, Seattle, WA; June 2018.
- Paez K, Heil SKR, Kilany M, Cowans T. Training Needs of Primary Care Providers Who Are Preparing To Offer Medication Assisted Treatment for Opioid Use Disorder. 2018 Centers for Medicare & Medicaid Services Quality Conference, Baltimore, MD; February 2018.
- Heil SKR, Cowans T, Johnson E, Cavazos J, Paez K. Delivering Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care: Understanding Physician Experiences and Challenges in Rural Oklahoma. American Public Health Association 145th Annual Meeting and Exposition, Atlanta, GA; November 2017.