TY - JOUR
KW - Adult
KW - Alcohol-Related Disorders/diagnosis/therapy
KW - Attitude of Health Personnel
KW - Buprenorphine/therapeutic use
KW - Cognitive Therapy
KW - Delayed-Action Preparations
KW - Delivery of Health Care/economics/organization & administration
KW - Feasibility Studies
KW - Female
KW - Financing, Government
KW - Humans
KW - Los Angeles
KW - Male
KW - Middle Aged
KW - Motivational Interviewing
KW - Naloxone/therapeutic use
KW - Naltrexone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Opioid-Related Disorders/diagnosis/therapy
KW - Primary Health Care/economics/organization & administration
KW - United States
KW - buprenorphine/naloxone
KW - care coordination
KW - collaborative care
KW - Evidence-based substance use disorder treatment
KW - Extended-release injectable naltrexone
KW - Implementation intervention
KW - medication-assisted treatment
KW - Organizational readiness
KW - primary care
KW - Suboxone(R)
KW - Vivitrol(R)
AU - Allison J. Ober
AU - Katherine E. Watkins
AU - Sarah B. Hunter
AU - Brett Ewing
AU - Karen Lamp
AU - Mimi Lind
AU - Kirsten Becker
AU - Keith Heinzerling
AU - Karen C. Osilla
AU - Allison L. Diamant
AU - Claude M. Setodji
A1 - 
AB - BACKGROUND: Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral -based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes. METHODS: To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes. RESULTS: After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly. CONCLUSIONS: Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
AD - RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. ober@rand.org.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA, 90405, USA.; Venice Family Clinic, 2509 Pico Boulevard, Santa Monica, CA, 90405, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; UCLA Department of Family Medicine, UCLA Family Health Center, 1920 Colorado Avenue, Santa Monica, CA, 90404, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.; UCLA Department of Internal Medicine, Division of General Internal Medicine, 911 Broxton Avenue, Los Angeles, CA, 90024, USA.; RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
BT - BMC family practice
C5 - Education & Workforce; Opioids & Substance Use
CP - 1
CY - England
DO - 10.1186/s12875-017-0673-6
IS - 1
JF - BMC family practice
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral -based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes. METHODS: To assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes. RESULTS: After 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly. CONCLUSIONS: Consistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
PP - England
PY - 2017
SN - 1471-2296; 1471-2296
SP - 107
T1 - Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study
T2 - BMC family practice
TI - Assessing and improving organizational readiness to implement substance use disorder treatment in primary care: findings from the SUMMIT study
U1 - Education & Workforce; Opioids & Substance Use
U2 - 29268702
U3 - 10.1186/s12875-017-0673-6
VL - 18
VO - 1471-2296; 1471-2296
Y1 - 2017
Y2 - Dec 21
ER -