TY - JOUR
KW - Health Services Accessibility/organization & administration
KW - Humans
KW - Interinstitutional Relations
KW - Medicaid/statistics & numerical data
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/diagnosis/drug therapy
KW - Pennsylvania
KW - Primary Health Care/economics/organization & administration
KW - Program Development
KW - Program Evaluation
KW - Quality of Health Care/organization & administration
KW - Referral and Consultation
KW - Research Design
KW - Rural Health Services/economics/organization & administration
KW - Social Work/organization & administration
KW - United States
KW - implementation
KW - medication assisted treatment
KW - opioid use disorder
KW - rural
AU - G. Cochran
AU - E. S. Cole
AU - J. Warwick
AU - J. M. Donohue
AU - A. J. Gordon
AU - W. F. Gellad
AU - T. Bear
AU - D. Kelley
AU - E. DiDomenico
AU - J. Pringle
A1 - 
AB - BACKGROUND: The continued escalation of opioid use disorder (OUD) calls for heightened vigilance to implement evidence-based care across the US. Rural care providers and patients have limited resources, and a number of barriers exist that can impede necessary OUD treatment services. This paper reports the design and protocol of an implementation study seeking to advance availability of medication assisted treatment (MAT) for OUD in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. METHODS: This project was a hybrid implementation study. Within a chronic care model paradigm, we employed the Framework for Systems Transformation to implement the American Society for Addiction Medicine care model for the use of medications in the treatment of OUD. In partnership with state leadership, Medicaid managed care organizations, local care management professionals, the Universities of Pittsburgh and Utah, primary care providers (PCP), and patients; the project team worked within 23 rural Pennsylvania counties to engage, recruit, train, and collaborate to implement the OUD service model in PCP practices from 2016 to 2019. Formative measures included practice-level metrics to monitor project implementation, and outcome measures involved employing Medicaid claims and encounter data to assess changes in provider/patient-level OUD-related metrics, such as MAT provider supply, prevalence of OUD, and MAT utilization. Descriptive statistics and repeated measures regression analyses were used to assess changes across the study period. DISCUSSION: There is an urgent need in the US to expand access to high quality, evidence-based OUD treatment-particularly in rural areas where capacity is limited for service delivery in order to improve patient health and protect lives. Importantly, this project leverages multiple partners to implement a theory- and practice-driven model of care for OUD. Results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
AD - Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA. jerry.cochran@hsc.utah.edu.; University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA.; University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA.; University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA.; Program for Addiction Research, Clinical Care, Education, and Advocacy, University of Utah School of Medicine, 30 N. 1900 E, Salt Lake City, UT, 84132, USA.; University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA.; University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA, 15261, USA.; Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA.; Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, USA.; University of Pittsburgh Program Evaluation Research Unit, 5631 Baum Blvd, Pittsburgh, PA, 15206, USA.; University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, USA.
BT - Addiction science & clinical practice
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-019-0154-4
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: The continued escalation of opioid use disorder (OUD) calls for heightened vigilance to implement evidence-based care across the US. Rural care providers and patients have limited resources, and a number of barriers exist that can impede necessary OUD treatment services. This paper reports the design and protocol of an implementation study seeking to advance availability of medication assisted treatment (MAT) for OUD in rural Pennsylvania counties for patients insured by Medicaid in primary care settings. METHODS: This project was a hybrid implementation study. Within a chronic care model paradigm, we employed the Framework for Systems Transformation to implement the American Society for Addiction Medicine care model for the use of medications in the treatment of OUD. In partnership with state leadership, Medicaid managed care organizations, local care management professionals, the Universities of Pittsburgh and Utah, primary care providers (PCP), and patients; the project team worked within 23 rural Pennsylvania counties to engage, recruit, train, and collaborate to implement the OUD service model in PCP practices from 2016 to 2019. Formative measures included practice-level metrics to monitor project implementation, and outcome measures involved employing Medicaid claims and encounter data to assess changes in provider/patient-level OUD-related metrics, such as MAT provider supply, prevalence of OUD, and MAT utilization. Descriptive statistics and repeated measures regression analyses were used to assess changes across the study period. DISCUSSION: There is an urgent need in the US to expand access to high quality, evidence-based OUD treatment-particularly in rural areas where capacity is limited for service delivery in order to improve patient health and protect lives. Importantly, this project leverages multiple partners to implement a theory- and practice-driven model of care for OUD. Results of this study will provide needed evidence in the field for appropriate methods for implementing MAT among a large number of rural primary care providers.
PY - 2019
SN - 1940-0640; 1940-0632; 1940-0632
SP - 019
EP - 4
EP - 25+
T1 - Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers
T2 - Addiction science & clinical practice
TI - Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
U2 - 31366408
U3 - 10.1186/s13722-019-0154-4
VL - 14
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2019
Y2 - Aug 1
ER -