TY - JOUR
AU - E. J. Austin
AU - J. Chen
AU - E. S. Briggs
AU - L. Ferro
AU - P. Barry
AU - A. Heald
AU - J. O. Merrill
AU - G. M. Curran
AU - A. J. Saxon
AU - J. C. Fortney
AU - A. D. Ratzliff
AU - E. C. Williams
A1 - 
AB - IMPORTANCE: Medication for opioid use disorder (MOUD) (eg, buprenorphine and naltrexone) can be offered in primary care, but barriers to implementation exist. OBJECTIVE: To evaluate an implementation intervention over 2 years to explore experiences and perspectives of multidisciplinary primary care (PC) teams initiating or expanding MOUD. DESIGN, SETTING, AND PARTICIPANTS: This survey-based and ethnographic qualitative study was conducted at 12 geographically and structurally diverse primary care clinics that enrolled in a hybrid effectiveness-implementation study from July 2020 to July 2022 and included PC teams (prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists). Survey data analysis was conducted from February to April 2022. EXPOSURE: Implementation intervention (external practice facilitation) to integrate OUD treatment alongside existing collaborative care for mental health services. MEASURES: Data included (1) quantitative surveys of primary care teams that were analyzed descriptively and triangulated with qualitative results and (2) qualitative field notes from ethnographic observation of clinic implementation meetings analyzed using rapid assessment methods. RESULTS: Sixty-two primary care team members completed the survey (41 female individuals [66%]; 1 [2%] American Indian or Alaskan Native, 4 [7%] Asian, 5 [8%] Black or African American, 5 [8%] Hispanic or Latino, 1 [2%] Native Hawaiian or Other Pacific Islander, and 46 [4%] White individuals), of whom 37 (60%) were between age 25 and 44 years. An analysis of implementation meetings (n = 362) and survey data identified 4 themes describing multilevel factors associated with PC team provision of MOUD during implementation, with variation in their experience across clinics. Themes characterized challenges with clinical administrative logistics that limited the capacity to provide rapid access to care and patient engagement as well as clinician confidence to discuss aspects of MOUD care with patients. These challenges were associated with conflicting attitudes among PC teams toward expanding MOUD care. CONCLUSIONS AND RELEVANCE: The results of this survey and qualitative study of PC team perspectives suggest that PC teams need flexibility in appointment scheduling and the capacity to effectively engage patients with OUD as well as ongoing training to maintain clinician confidence in the face of evolving opioid-related clinical issues. Future work should address structural challenges associated with workload burden and limited schedule flexibility that hinder MOUD expansion in PC settings.
AD - Department of Health Systems and Population Health, School of Public Health University of Washington, Seattle.;Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle.;Advancing Integrated Mental Health Solutions Center, University of Washington, Seattle.;Department of Medicine, School of Medicine, University of Washington, Seattle.;Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock.;Central Arkansas Veterans Health Care System.;Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, Washington.;Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound, Seattle, Washington.
AN - 37566414
BT - JAMA Netw Open
C5 - Opioids & Substance Use; Healthcare Disparities; Education & Workforce
CP - 8
DA - Aug 1
DO - 10.1001/jamanetworkopen.2023.28627
DP - NLM
ET - 20230801
IS - 8
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: Medication for opioid use disorder (MOUD) (eg, buprenorphine and naltrexone) can be offered in primary care, but barriers to implementation exist. OBJECTIVE: To evaluate an implementation intervention over 2 years to explore experiences and perspectives of multidisciplinary primary care (PC) teams initiating or expanding MOUD. DESIGN, SETTING, AND PARTICIPANTS: This survey-based and ethnographic qualitative study was conducted at 12 geographically and structurally diverse primary care clinics that enrolled in a hybrid effectiveness-implementation study from July 2020 to July 2022 and included PC teams (prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists). Survey data analysis was conducted from February to April 2022. EXPOSURE: Implementation intervention (external practice facilitation) to integrate OUD treatment alongside existing collaborative care for mental health services. MEASURES: Data included (1) quantitative surveys of primary care teams that were analyzed descriptively and triangulated with qualitative results and (2) qualitative field notes from ethnographic observation of clinic implementation meetings analyzed using rapid assessment methods. RESULTS: Sixty-two primary care team members completed the survey (41 female individuals [66%]; 1 [2%] American Indian or Alaskan Native, 4 [7%] Asian, 5 [8%] Black or African American, 5 [8%] Hispanic or Latino, 1 [2%] Native Hawaiian or Other Pacific Islander, and 46 [4%] White individuals), of whom 37 (60%) were between age 25 and 44 years. An analysis of implementation meetings (n = 362) and survey data identified 4 themes describing multilevel factors associated with PC team provision of MOUD during implementation, with variation in their experience across clinics. Themes characterized challenges with clinical administrative logistics that limited the capacity to provide rapid access to care and patient engagement as well as clinician confidence to discuss aspects of MOUD care with patients. These challenges were associated with conflicting attitudes among PC teams toward expanding MOUD care. CONCLUSIONS AND RELEVANCE: The results of this survey and qualitative study of PC team perspectives suggest that PC teams need flexibility in appointment scheduling and the capacity to effectively engage patients with OUD as well as ongoing training to maintain clinician confidence in the face of evolving opioid-related clinical issues. Future work should address structural challenges associated with workload burden and limited schedule flexibility that hinder MOUD expansion in PC settings.
PY - 2023
SN - 2574-3805
SP - e2328627
ST - Integrating Opioid Use Disorder Treatment Into Primary Care Settings
T1 - Integrating Opioid Use Disorder Treatment Into Primary Care Settings
T2 - JAMA Netw Open
TI - Integrating Opioid Use Disorder Treatment Into Primary Care Settings
U1 - Opioids & Substance Use; Healthcare Disparities; Education & Workforce
U3 - 10.1001/jamanetworkopen.2023.28627
VL - 6
VO - 2574-3805
Y1 - 2023
ER -