TY - JOUR
KW - Medication treatment for OUD (MOUD)
KW - buprenorphine
KW - opioid use disorder
KW - Telemedicine
AU - N. Brunet
AU - D. T. Moore
AU - Lendvai Wischik
AU - K. M. Mattocks
AU - M. I. Rosen
A1 - 
AB - Background: Having prescribers use clinical video teleconferencing (telemedicine) to prescribe buprenorphine to people with opioid use disorder (OUD) has shown promise but its implementation is challenging. We describe barriers, facilitators and lessons learned while implementing a system to remotely prescribe buprenorphine to Veterans in rural settings. Methods: We conducted a quality improvement project aimed at increasing the availability of medications for OUD (MOUD) to Veterans. This project focused on tele-prescribing buprenorphine to rural sites via a hub (centralized prescribers) and spoke (rural clinics) model. After soliciting a wide-range of inputs from site visits, qualitative interviews of key stakeholders at rural sites, and review of preliminary cases, a "how-to" toolkit was developed and iteratively refined to guide tele-prescribing of buprenorphine. After internal and external facilitation strategies were employed, Veterans with OUD at three clinics were transitioned to buprenorphine treatment via telemedicine. Results: Factors impacting adoption of the tele-prescribing intervention were mapped to the Consolidated Framework for Implementation Research (CFIR) constructs. Barriers to adoption included concerns about legality of tele-prescribing a controlled substance, conflicting interests between different stakeholders, and coordination with an existing buprenorphine program requiring more attendance and abstinence from Veterans than the tele-prescribing program required. Factors facilitating adoption included a sense of mission around combating the opioid epidemic, preexisting use of and comfort with tele-prescribing, and rural sites' control over Veterans referred to tele-prescribers. A total of 12 patients from rural areas were successfully transitioned onto buprenorphine, of whom 9 remained on buprenorphine 6 months after initiation of treatment. Conclusions: Implementing tele-prescribing was negotiated with stakeholders at the target clinics and operationalized in a toolkit to guide future efforts. Implementation issues can be addressed by activities that foster collaboration between hubs (centralized prescribers) and spokes (rural clinics) and by a toolkit that operationalizes tele-prescribing procedures.
AD - VA Maine Healthcare System, Augusta, ME, USA.; Yale University Department of Psychiatry, New Haven, CT, USA.; VA Connecticut Health System West Haven Campus, West Haven, CT, USA.; VA Connecticut Health System West Haven Campus, West Haven, CT, USA.; VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.; Yale University Department of Psychiatry, New Haven, CT, USA.; VA Connecticut Health System West Haven Campus, West Haven, CT, USA.
BT - Substance abuse
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Measures; Opioids & Substance Use
CY - United States
DO - 10.1080/08897077.2020.1728466
JF - Substance abuse
LA - eng
M1 - Journal Article
N2 - Background: Having prescribers use clinical video teleconferencing (telemedicine) to prescribe buprenorphine to people with opioid use disorder (OUD) has shown promise but its implementation is challenging. We describe barriers, facilitators and lessons learned while implementing a system to remotely prescribe buprenorphine to Veterans in rural settings. Methods: We conducted a quality improvement project aimed at increasing the availability of medications for OUD (MOUD) to Veterans. This project focused on tele-prescribing buprenorphine to rural sites via a hub (centralized prescribers) and spoke (rural clinics) model. After soliciting a wide-range of inputs from site visits, qualitative interviews of key stakeholders at rural sites, and review of preliminary cases, a "how-to" toolkit was developed and iteratively refined to guide tele-prescribing of buprenorphine. After internal and external facilitation strategies were employed, Veterans with OUD at three clinics were transitioned to buprenorphine treatment via telemedicine. Results: Factors impacting adoption of the tele-prescribing intervention were mapped to the Consolidated Framework for Implementation Research (CFIR) constructs. Barriers to adoption included concerns about legality of tele-prescribing a controlled substance, conflicting interests between different stakeholders, and coordination with an existing buprenorphine program requiring more attendance and abstinence from Veterans than the tele-prescribing program required. Factors facilitating adoption included a sense of mission around combating the opioid epidemic, preexisting use of and comfort with tele-prescribing, and rural sites' control over Veterans referred to tele-prescribers. A total of 12 patients from rural areas were successfully transitioned onto buprenorphine, of whom 9 remained on buprenorphine 6 months after initiation of treatment. Conclusions: Implementing tele-prescribing was negotiated with stakeholders at the target clinics and operationalized in a toolkit to guide future efforts. Implementation issues can be addressed by activities that foster collaboration between hubs (centralized prescribers) and spokes (rural clinics) and by a toolkit that operationalizes tele-prescribing procedures.
PP - United States
PY - 2020
SN - 1547-0164; 0889-7077
SP - 1
EP - 8
EP - 
T1 - Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine
T2 - Substance abuse
TI - Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth; Measures; Opioids & Substance Use
U2 - 32078492
U3 - 10.1080/08897077.2020.1728466
VO - 1547-0164; 0889-7077
Y1 - 2020
Y2 - Feb 20
ER -