TY - JOUR
AU - E. C. Williams
AU - M. C. Frost
AU - A. N. Danner
AU - A. M. K. Lott
AU - C. E. Achtmeyer
AU - C. L. Hood
AU - C. A. Malte
AU - A. J. Saxon
AU - E. J. Hawkins
A1 - 
AB - OBJECTIVES: Medication treatment for opioid use disorder (MOUD) is effective and recommended for outpatient settings. We implemented and evaluated the SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center-a quality improvement partnership to implement stepped care for MOUD in 2 Veterans Health Administration (VA) primary care (PC) clinics. METHODS: SUPPORT provided a dedicated clinical team (nurse practitioner prescriber and social worker) and stepped care ([1] identification, assessment, referral; [2] MOUD induction; [3] stabilization; and [4] maintenance supporting PC providers [PCPs] to initiate and/or sustain treatment) coupled with ongoing internal facilitation (consultation, trainings, informatics support). Qualitative interviews with stakeholders (PCPs and patients) and meeting notes identified barriers and facilitators to implementation. Electronic health record and patient tracking data measured reach, adoption, and implementation outcomes descriptively. RESULTS: SUPPORT's implementation barriers included the need for an X-waiver, VA's opioid tapering policies, patient and PCP knowledge gaps and PCP discomfort, and logistical compatibility and sustainability challenges for clinics. SUPPORT's dedicated clinical staff, ongoing internal facilitation, and high patient and PCP satisfaction were key facilitators. SUPPORT (January 2019 to September 2021) trained 218 providers; 63 received X-waivers, and 23 provided MOUD (10.5% of those trained). SUPPORT provided care to 167 patients, initiated MOUD for 33, and provided education and naloxone to 72 (all = 0 in year before launch). CONCLUSIONS: SUPPORT reached many PCPs and patients and resulted in small increases in MOUD prescribing and high levels of stakeholder satisfaction. Dedicated clinical staff was key to observed successes. Although resource-intensive, SUPPORT offers a potential model for outpatient MOUD provision.
AD - From the Health Services Research & Development (HSR&D), Seattle Center of Innovation for Veteran-centered and Value-driven Care, Veterans Affairs (VA), Puget Sound Healthcare System, Seattle, WA (ECW, MCF, AND, AMKL, CAM, EJH); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (ECW, MCF); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA (AND, AMKL, CEA, CLH, CAM, AJS, EJH); and Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (AJS, EJH).
AN - 38385548
BT - J Addict Med
C5 - Opioids & Substance Use; Education & Workforce; Healthcare Disparities
DA - Feb 29
DO - 10.1097/adm.0000000000001277
DP - NLM
ET - 20240229
JF - J Addict Med
LA - eng
N2 - OBJECTIVES: Medication treatment for opioid use disorder (MOUD) is effective and recommended for outpatient settings. We implemented and evaluated the SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center-a quality improvement partnership to implement stepped care for MOUD in 2 Veterans Health Administration (VA) primary care (PC) clinics. METHODS: SUPPORT provided a dedicated clinical team (nurse practitioner prescriber and social worker) and stepped care ([1] identification, assessment, referral; [2] MOUD induction; [3] stabilization; and [4] maintenance supporting PC providers [PCPs] to initiate and/or sustain treatment) coupled with ongoing internal facilitation (consultation, trainings, informatics support). Qualitative interviews with stakeholders (PCPs and patients) and meeting notes identified barriers and facilitators to implementation. Electronic health record and patient tracking data measured reach, adoption, and implementation outcomes descriptively. RESULTS: SUPPORT's implementation barriers included the need for an X-waiver, VA's opioid tapering policies, patient and PCP knowledge gaps and PCP discomfort, and logistical compatibility and sustainability challenges for clinics. SUPPORT's dedicated clinical staff, ongoing internal facilitation, and high patient and PCP satisfaction were key facilitators. SUPPORT (January 2019 to September 2021) trained 218 providers; 63 received X-waivers, and 23 provided MOUD (10.5% of those trained). SUPPORT provided care to 167 patients, initiated MOUD for 33, and provided education and naloxone to 72 (all = 0 in year before launch). CONCLUSIONS: SUPPORT reached many PCPs and patients and resulted in small increases in MOUD prescribing and high levels of stakeholder satisfaction. Dedicated clinical staff was key to observed successes. Although resource-intensive, SUPPORT offers a potential model for outpatient MOUD provision.
PY - 2024
SN - 1932-0620
ST - "The Only Reason I Am Willing to Do It at All": Evaluation of VA's SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center
T1 - "The Only Reason I Am Willing to Do It at All": Evaluation of VA's SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center
T2 - J Addict Med
TI - "The Only Reason I Am Willing to Do It at All": Evaluation of VA's SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center
U1 - Opioids & Substance Use; Education & Workforce; Healthcare Disparities
U3 - 10.1097/adm.0000000000001277
VO - 1932-0620
Y1 - 2024
ER -