TY - JOUR
KW - X-waiver
KW - buprenorphine
KW - complementary and integrative health
KW - Medications for opioid use disorder
KW - opioid use disorder
AU - E. T. Chang
AU - R. S. Oberman
AU - A. N. Cohen
AU - S. L. Taylor
AU - E. Gumm
AU - A. S. Mardian
AU - S. Toy
AU - A. Revote
AU - B. Lewkowitz
AU - E. M. Yano
A1 - 
AB - OBJECTIVES: Evidence-based therapies for opioid use disorder (OUD) and chronic pain, such as medications for OUD (MOUD) and complementary and integrative health (CIH; e.g., acupuncture and meditation) therapies, exist. However, their adoption has been slow, particularly in primary care, due to numerous implementation challenges. We sought to expand the use of MOUD and CIH within primary care by using an evidence-based quality improvement (EBQI) implementation strategy. METHODS: We used EBQI to engage two facilities in the Veterans Health Administration (VHA) from June 2018 to September 2019. EBQI included multilevel stakeholder engagement, with external facilitators providing technical support, practice facilitation, and routine data feedback. We established a quality improvement (QI) team at each facility with diverse stakeholders (e.g., primary care, addiction, pain, nursing, pharmacy). We met monthly with regional stakeholders to address implementation barriers. We also convened an advisory board to ensure alignment with national priorities. RESULTS: Pre-implementation interviews indicated facility-level and provider-level barriers to prescribing buprenorphine, including strong primary care provider resistance. Both facilities developed action plans. They both conducted educational meetings (e.g., Grand Rounds, MOUD waiver trainings). Facility A also offered clinical preceptorships for newly trained primary care prescribers. Facility B used mass media and mailings to educate patients about MOUD and CIH options and dashboards to identify potential candidates for MOUD. After 15 months, both facilities increased their OUD treatment rates to the ≥ 90th percentile of VHA medical centers nationally. Exit interviews indicated an attitudinal shift in MOUD delivery in primary care. Stakeholders valued the EBQI process, particularly cross-site collaboration. IMPLICATIONS: Despite initial implementation barriers, we effectively engaged stakeholders using EBQI strategies. Local QI teams used an assortment of QI interventions and developed tools to catapult their facilities to among the highest performers in VHA OUD treatment. IMPACTS: EBQI is an effective strategy to partner with stakeholders to implement MOUD and CIH therapies.
AD - VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Evelyn.Chang@va.gov.; Department of General Internal Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Evelyn.Chang@va.gov.; Division of General Internal Medicine, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. Evelyn.Chang@va.gov.; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA.; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; VA Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), VA Greater Los Angeles Healthcare Center, Los Angeles, CA, USA.; Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; Division of General Internal Medicine, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.; Department of Health Policy & Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.; Southern Arizona VA Health Care System, Tucson, AZ, USA.; Chronic Pain Wellness Center, Phoenix VA Health Care System, Phoenix, AZ, USA.; Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.; Primary Care, South Texas Veterans Healthcare System, San Antonio, TX, USA.; Primary Care, South Texas Veterans He(TRUNCATED)
BT - Journal of general internal medicine
C5 - Education & Workforce; Opioids & Substance Use
CP - Suppl 3
DO - 10.1007/s11606-020-06255-6
IS - Suppl 3
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - OBJECTIVES: Evidence-based therapies for opioid use disorder (OUD) and chronic pain, such as medications for OUD (MOUD) and complementary and integrative health (CIH; e.g., acupuncture and meditation) therapies, exist. However, their adoption has been slow, particularly in primary care, due to numerous implementation challenges. We sought to expand the use of MOUD and CIH within primary care by using an evidence-based quality improvement (EBQI) implementation strategy. METHODS: We used EBQI to engage two facilities in the Veterans Health Administration (VHA) from June 2018 to September 2019. EBQI included multilevel stakeholder engagement, with external facilitators providing technical support, practice facilitation, and routine data feedback. We established a quality improvement (QI) team at each facility with diverse stakeholders (e.g., primary care, addiction, pain, nursing, pharmacy). We met monthly with regional stakeholders to address implementation barriers. We also convened an advisory board to ensure alignment with national priorities. RESULTS: Pre-implementation interviews indicated facility-level and provider-level barriers to prescribing buprenorphine, including strong primary care provider resistance. Both facilities developed action plans. They both conducted educational meetings (e.g., Grand Rounds, MOUD waiver trainings). Facility A also offered clinical preceptorships for newly trained primary care prescribers. Facility B used mass media and mailings to educate patients about MOUD and CIH options and dashboards to identify potential candidates for MOUD. After 15 months, both facilities increased their OUD treatment rates to the ≥ 90th percentile of VHA medical centers nationally. Exit interviews indicated an attitudinal shift in MOUD delivery in primary care. Stakeholders valued the EBQI process, particularly cross-site collaboration. IMPLICATIONS: Despite initial implementation barriers, we effectively engaged stakeholders using EBQI strategies. Local QI teams used an assortment of QI interventions and developed tools to catapult their facilities to among the highest performers in VHA OUD treatment. IMPACTS: EBQI is an effective strategy to partner with stakeholders to implement MOUD and CIH therapies.
PY - 2020
SN - 1525-1497; 0884-8734; 0884-8734
SP - 918
EP - 926
EP - 
T1 - Increasing Access to Medications for Opioid Use Disorder and Complementary and Integrative Health Services in Primary Care
T2 - Journal of general internal medicine
TI - Increasing Access to Medications for Opioid Use Disorder and Complementary and Integrative Health Services in Primary Care
U1 - Education & Workforce; Opioids & Substance Use
U2 - 33145686
U3 - 10.1007/s11606-020-06255-6
VL - 35
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2020
Y2 - Dec
ER -