TY - JOUR
KW - Adult
KW - Alcoholism/therapy
KW - Child, Preschool
KW - Delivery of Health Care, Integrated/organization & administration
KW - Evidence-Based Practice
KW - Female
KW - Humans
KW - Opioid-Related Disorders/therapy
KW - Primary Health Care/methods/organization & administration
KW - Behavioral health care integration
KW - Mixed Methods
KW - Sustainment
AU - Sarah B. Hunter
AU - Allison J. Ober
AU - Colleen M. McCullough
AU - Erik D. Storholm
AU - Praise O. Iyiewuare
AU - Chau Pham
AU - Katherine E. Watkins
A1 - 
AB - BACKGROUND: Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS: Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed. Treatment practices from the intervention period were compared to practices after the intervention period to examine whether the practices were sustained. Data from staff surveys and interviews were used to examine the factors related to sustainment. RESULTS: The two clinics sustained multiple components of AOUD care 1 year following the end of implementation support, including care coordination, psychotherapy, and medication-assisted treatment. Some of the practices were modified over time, for example, screening became less frequent by design, while use of care coordination and psychotherapy for AOUDs expanded. Participants identified staff training and funding for medications as key challenges to sustaining treatment. CONCLUSIONS: Following a multi-year implementation intervention, a large FQHC continued to deliver AOUD treatment. Access to external funding and staff support appeared to be critical elements for sustaining care over time. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01810159.
AD - RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA. shunter@rand.org.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
BT - Implementation science : IS
C5 - Education & Workforce; Opioids & Substance Use
CP - 1
CY - England
DO - 10.1186/s13012-018-0777-y
IS - 1
JF - Implementation science : IS
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Efforts to integrate substance use disorder treatment into primary care settings are growing. Little is known about how well primary care settings can sustain treatment delivery to address substance use following the end of implementation support. METHODS: Data from two clinics operated by one multi-site federally qualified health center (FQHC) in the US, including administrative data, staff surveys, interviews, and focus groups, were used to gather information about changes in organizational capacity related to alcohol and opioid use disorder (AOUD) treatment delivery during and after a multi-year implementation intervention was executed. Treatment practices from the intervention period were compared to practices after the intervention period to examine whether the practices were sustained. Data from staff surveys and interviews were used to examine the factors related to sustainment. RESULTS: The two clinics sustained multiple components of AOUD care 1 year following the end of implementation support, including care coordination, psychotherapy, and medication-assisted treatment. Some of the practices were modified over time, for example, screening became less frequent by design, while use of care coordination and psychotherapy for AOUDs expanded. Participants identified staff training and funding for medications as key challenges to sustaining treatment. CONCLUSIONS: Following a multi-year implementation intervention, a large FQHC continued to deliver AOUD treatment. Access to external funding and staff support appeared to be critical elements for sustaining care over time. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01810159.
PP - England
PY - 2018
SN - 1748-5908; 1748-5908
SP - 83
T1 - Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study
T2 - Implementation science : IS
TI - Sustaining alcohol and opioid use disorder treatment in primary care: a mixed methods study
U1 - Education & Workforce; Opioids & Substance Use
U2 - 29914524
U3 - 10.1186/s13012-018-0777-y
VL - 13
VO - 1748-5908; 1748-5908
Y1 - 2018
Y2 - Jun 18
ER -