TY - JOUR
KW - Aged
KW - Cohort Studies
KW - Female
KW - Health Services Accessibility/statistics & numerical data
KW - Humans
KW - Male
KW - Middle Aged
KW - Opiate Substitution Treatment/statistics & numerical data
KW - Opioid-Related Disorders/drug therapy/epidemiology
KW - Primary Health Care/organization & administration
KW - United States
KW - United States Department of Veterans Affairs
KW - Veterans/statistics & numerical data
KW - Veterans Health Services/organization & administration
AU - E. J. Hawkins
AU - C. A. Malte
AU - A. J. Gordon
AU - E. C. Williams
AU - H. J. Hagedorn
AU - K. Drexler
AU - B. E. Blanchard
AU - J. L. Burden
AU - J. Knoeppel
AU - A. N. Danner
AU - A. Lott
AU - J. G. Liberto
AU - A. J. Saxon
A1 - 
AB - IMPORTANCE: With increasing rates of opioid use disorder (OUD) and overdose deaths in the US, increased access to medications for OUD (MOUD) is paramount. Rigorous effectiveness evaluations of large-scale implementation initiatives using quasi-experimental designs are needed to inform expansion efforts. OBJECTIVE: To evaluate a US Department of Veterans Affairs (VA) initiative to increase MOUD use in nonaddiction clinics. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement initiative used interrupted time series design to compare trends in MOUD receipt. Primary care, pain, and mental health clinics in the VA health care system (n = 35) located at 18 intervention facilities and nonintervention comparison clinics (n = 35) were matched on preimplementation MOUD prescribing trends, clinic size, and facility complexity. The cohort of patients with OUD who received care in intervention or comparison clinics in the year after September 1, 2018, were evaluated. The preimplementation period extended from September 1, 2017, through August 31, 2018, and the postimplementation period from September 1, 2018, through August 31, 2019. EXPOSURES: The multifaceted implementation intervention included education, external facilitation, and quarterly reports. MAIN OUTCOMES AND MEASURES: The main outcomes were the proportion of patients receiving MOUD and the number of patients per clinician prescribing MOUD. Segmented logistic regression evaluated monthly proportions of MOUD receipt 1 year before and after initiative launch, adjusting for demographic and clinical covariates. Poisson regression models examined yearly changes in clinician prescribing over the same time frame. RESULTS: Overall, 7488 patients were seen in intervention clinics (mean [SD] age, 53.3 [14.2] years; 6858 [91.6%] male; 1476 [19.7%] Black, 417 [5.6%] Hispanic; 5162 [68.9%] White; 239 [3.2%] other race [including American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiple races]; and 194 [2.6%] unknown) and 7558 in comparison clinics (mean [SD] age, 53.4 [14.0] years; 6943 [91.9%] male; 1463 [19.4%] Black; 405 [5.4%] Hispanic; 5196 [68.9%] White; 244 [3.2%] other race; 250 [3.3%] unknown). During the preimplementation year, the proportion of patients receiving MOUD in intervention clinics increased monthly by 5.0% (adjusted odds ratio [AOR], 1.05; 95% CI, 1.03-1.07). Accounting for this preimplementation trend, the proportion of patients receiving MOUD increased monthly by an additional 2.3% (AOR, 1.02; 95% CI, 1.00-1.04) during the implementation year. Comparison clinics increased by 2.6% monthly before implementation (AOR, 1.03; 95% CI, 1.01-1.04), with no changes detected after implementation. Although preimplementation-year trends in monthly MOUD receipt were similar in intervention and comparison clinics, greater increases were seen in intervention clinics after implementation (AOR, 1.04; 95% CI, 1.01-1.08). Patients treated with MOUD per clinician in intervention clinics saw greater increases from before to after implementation compared with comparison clinics (incidence rate ratio, 1.50; 95% CI, 1.28-1.77). CONCLUSIONS AND RELEVANCE: A multifaceted implementation initiative in nonaddiction clinics was associated with increased MOUD prescribing. Findings suggest that engagement of clinicians in general clinical settings may increase MOUD access.
AD - Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.; Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.; Informatics, Decision-Enhancement, and Analytic Sciences Center, Health Services Research & Development, VA Salt Lake City Health Care System, Salt Lake City, Utah.; Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.; Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Department of Health Systems and Population Health, University of Washington, Seattle.; Center for Care Delivery & Outcomes Research, Health Services Research & Development, Minneapolis VA Health Care System, Minneapolis, Minnesota.; Department of Psychiatry, University of Minnesota, Minneapolis.; Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC.; Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.; Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington, DC.; Office of Mental Health and Suici(TRUNCATED)
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 12
DO - 10.1001/jamanetworkopen.2021.37238
IS - 12
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: With increasing rates of opioid use disorder (OUD) and overdose deaths in the US, increased access to medications for OUD (MOUD) is paramount. Rigorous effectiveness evaluations of large-scale implementation initiatives using quasi-experimental designs are needed to inform expansion efforts. OBJECTIVE: To evaluate a US Department of Veterans Affairs (VA) initiative to increase MOUD use in nonaddiction clinics. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement initiative used interrupted time series design to compare trends in MOUD receipt. Primary care, pain, and mental health clinics in the VA health care system (n = 35) located at 18 intervention facilities and nonintervention comparison clinics (n = 35) were matched on preimplementation MOUD prescribing trends, clinic size, and facility complexity. The cohort of patients with OUD who received care in intervention or comparison clinics in the year after September 1, 2018, were evaluated. The preimplementation period extended from September 1, 2017, through August 31, 2018, and the postimplementation period from September 1, 2018, through August 31, 2019. EXPOSURES: The multifaceted implementation intervention included education, external facilitation, and quarterly reports. MAIN OUTCOMES AND MEASURES: The main outcomes were the proportion of patients receiving MOUD and the number of patients per clinician prescribing MOUD. Segmented logistic regression evaluated monthly proportions of MOUD receipt 1 year before and after initiative launch, adjusting for demographic and clinical covariates. Poisson regression models examined yearly changes in clinician prescribing over the same time frame. RESULTS: Overall, 7488 patients were seen in intervention clinics (mean [SD] age, 53.3 [14.2] years; 6858 [91.6%] male; 1476 [19.7%] Black, 417 [5.6%] Hispanic; 5162 [68.9%] White; 239 [3.2%] other race [including American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiple races]; and 194 [2.6%] unknown) and 7558 in comparison clinics (mean [SD] age, 53.4 [14.0] years; 6943 [91.9%] male; 1463 [19.4%] Black; 405 [5.4%] Hispanic; 5196 [68.9%] White; 244 [3.2%] other race; 250 [3.3%] unknown). During the preimplementation year, the proportion of patients receiving MOUD in intervention clinics increased monthly by 5.0% (adjusted odds ratio [AOR], 1.05; 95% CI, 1.03-1.07). Accounting for this preimplementation trend, the proportion of patients receiving MOUD increased monthly by an additional 2.3% (AOR, 1.02; 95% CI, 1.00-1.04) during the implementation year. Comparison clinics increased by 2.6% monthly before implementation (AOR, 1.03; 95% CI, 1.01-1.04), with no changes detected after implementation. Although preimplementation-year trends in monthly MOUD receipt were similar in intervention and comparison clinics, greater increases were seen in intervention clinics after implementation (AOR, 1.04; 95% CI, 1.01-1.08). Patients treated with MOUD per clinician in intervention clinics saw greater increases from before to after implementation compared with comparison clinics (incidence rate ratio, 1.50; 95% CI, 1.28-1.77). CONCLUSIONS AND RELEVANCE: A multifaceted implementation initiative in nonaddiction clinics was associated with increased MOUD prescribing. Findings suggest that engagement of clinicians in general clinical settings may increase MOUD access.
PY - 2021
SN - 2574-3805; 2574-3805
T1 - Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System
T2 - JAMA network open
TI - Accessibility to Medication for Opioid Use Disorder After Interventions to Improve Prescribing Among Nonaddiction Clinics in the US Veterans Health Care System
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 34870679
U3 - 10.1001/jamanetworkopen.2021.37238
VL - 4
VO - 2574-3805; 2574-3805
Y1 - 2021
Y2 - Dec 1
ER -