TY - JOUR
KW - Confidentiality
KW - Group Processes
KW - Humans
KW - Opioid-Related Disorders/therapy
KW - Patient Care Team
KW - Patient Participation
KW - Psychotherapy, Group/organization & administration/standards
KW - Qualitative Research
KW - Buprenorphine–naloxone
KW - GBOT
KW - Group Psychotherapy
KW - group visit
KW - implementation science
KW - shared medical appointment
AU - R. Sokol
AU - M. Albanese
AU - A. Chew
AU - J. Early
AU - E. Grossman
AU - D. Roll
AU - G. Sawin
AU - D. J. Wu
AU - Z. Schuman-Olivier
A1 - 
AB - BACKGROUND: Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? METHODS: To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components. RESULTS: We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. CONCLUSION: While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.
AD - Malden Family Medicine Center, 195 Canal St, Malden, MA, 02148, USA. rsokol@challiance.org.; Outpatient Addiction Services, 26 Central St, Somerville, MA, 02143, USA.; Malden Family Medicine Center, 195 Canal St, Malden, MA, 02148, USA.; Malden Family Medicine Center, 195 Canal St, Malden, MA, 02148, USA.; Somerville Hospital Primary Care, 236 Highland Avenue, Somerville, MA, 02143, USA.; Revere Care Center, 454 Broadway, Revere, MA, 02151, USA.; Malden Family Medicine Center, 195 Canal St, Malden, MA, 02148, USA.; Malden Family Medicine Center, 195 Canal St, Malden, MA, 02148, USA.; Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA, 02141, USA.
BT - Addiction science & clinical practice
C5 - Education & Workforce; Opioids & Substance Use
CP - 1
DO - 10.1186/s13722-019-0176-y
IS - 1
JF - Addiction science & clinical practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? METHODS: To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components. RESULTS: We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. CONCLUSION: While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.
PY - 2019
SN - 1940-0640; 1940-0632; 1940-0632
SP - 019
EP - y
EP - 47+
T1 - Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation
T2 - Addiction science & clinical practice
TI - Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation
U1 - Education & Workforce; Opioids & Substance Use
U2 - 31882001
U3 - 10.1186/s13722-019-0176-y
VL - 14
VO - 1940-0640; 1940-0632; 1940-0632
Y1 - 2019
Y2 - Dec 27
ER -