TY - JOUR
AU - H. L. Surratt
AU - M. R. Lofwall
AU - E. O. Nelson
AU - A. C. Thornton
AU - E. V. Cari
AU - S. L. Walsh
AU - L. C. Fanucchi
A1 - 
AB - BACKGROUND: Rising rates of serious injection-related infections (SIRI) and hospitalizations have been documented nationally in the context of the ongoing opioid and polysubstance use epidemic in the United States. This qualitative interview study assessed multi-level facilitators and barriers to the implementation of an integrated inpatient opioid use disorder (OUD) and SIRI care intervention among organizational stakeholders in the healthcare setting as a secondary aim of a randomized clinical trial. METHODS: The PRISM (Practical, Robust, Implementation, and Sustainability Model) implementation science framework guided stakeholder interviews. Eligible stakeholders were at least 18 years old and employed in an inpatient or outpatient care setting that served the study patient population. Qualitative interviews assessed contextual factors that supported or hindered the implementation of the novel study intervention and priorities for sustainability and future investment. Interviews lasted approximately 60 min. Qualitative coding and analysis were conducted in NVivo. RESULTS: Overall, thirteen stakeholders were interviewed, including clinicians from cardiothoracic surgery, hospital medicine, infectious disease, and addiction medicine, hospital administrators, social work and case management staff, pharmacists, Bridge Clinic staff, and staff from home infusion. Within the four overarching PRISM domains thirteen critical elements were activated by the study intervention that represented key barriers and facilitators to implementation, including: Intervention (Coordination across departments, Strength of the evidence base, Burden, Barriers of frontline staff, SUD stigma); Recipients (Clinical leadership, Organizational health and culture; Patient disease burden, Patient demographics); External Environment (Community Resources, Reimbursement); and Implementation and Sustainability Infrastructure (Dedicated team, Plan for sustainability). CONCLUSIONS: Examination of implementation determinants highlighted organizational and external barriers and facilitators. Barriers centered on the complexities of care coordination across departments, the inpatient-outpatient transition, and specialized training needs; these appeared modifiable through adoption of specific implementation strategies. The presence of critical clinical infrastructure to support this transitional OUD-SIRI integrated care model was an essential facilitator, which could represent a challenge for other health systems. External factors, including low resource availability, and SUD-related stigma that excludes patients from opportunities to receive care in the community, collectively pose challenges to wider implementation and sustainability.
AD - UKCOM, Department of Behavioral Science, Center on Drug and Alcohol Research, Lexington, KY, United States of America. Electronic address: hilary.surratt@uky.edu.; UKCOM, Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, Lexington, KY, United States of America.; UKCOM, Department of Behavioral Science, Lexington, KY, United States of America.; UKCOM, Department of Internal Medicine, Division of Infectious Diseases, Lexington, KY, United States of America.; UKCOM, Department of Internal Medicine, Division of Infectious Diseases, Center on Drug and Alcohol Research, Lexington, KY, United States of America.
AN - 42155647
BT - J Subst Use Addict Treat
C5 - Opioids & Substance Use
DA - 10/2026
DO - 10.1016/j.josat.2026.210025
DP - NLM
ET - 20260519
JF - J Subst Use Addict Treat
LA - eng
N2 - BACKGROUND: Rising rates of serious injection-related infections (SIRI) and hospitalizations have been documented nationally in the context of the ongoing opioid and polysubstance use epidemic in the United States. This qualitative interview study assessed multi-level facilitators and barriers to the implementation of an integrated inpatient opioid use disorder (OUD) and SIRI care intervention among organizational stakeholders in the healthcare setting as a secondary aim of a randomized clinical trial. METHODS: The PRISM (Practical, Robust, Implementation, and Sustainability Model) implementation science framework guided stakeholder interviews. Eligible stakeholders were at least 18 years old and employed in an inpatient or outpatient care setting that served the study patient population. Qualitative interviews assessed contextual factors that supported or hindered the implementation of the novel study intervention and priorities for sustainability and future investment. Interviews lasted approximately 60 min. Qualitative coding and analysis were conducted in NVivo. RESULTS: Overall, thirteen stakeholders were interviewed, including clinicians from cardiothoracic surgery, hospital medicine, infectious disease, and addiction medicine, hospital administrators, social work and case management staff, pharmacists, Bridge Clinic staff, and staff from home infusion. Within the four overarching PRISM domains thirteen critical elements were activated by the study intervention that represented key barriers and facilitators to implementation, including: Intervention (Coordination across departments, Strength of the evidence base, Burden, Barriers of frontline staff, SUD stigma); Recipients (Clinical leadership, Organizational health and culture; Patient disease burden, Patient demographics); External Environment (Community Resources, Reimbursement); and Implementation and Sustainability Infrastructure (Dedicated team, Plan for sustainability). CONCLUSIONS: Examination of implementation determinants highlighted organizational and external barriers and facilitators. Barriers centered on the complexities of care coordination across departments, the inpatient-outpatient transition, and specialized training needs; these appeared modifiable through adoption of specific implementation strategies. The presence of critical clinical infrastructure to support this transitional OUD-SIRI integrated care model was an essential facilitator, which could represent a challenge for other health systems. External factors, including low resource availability, and SUD-related stigma that excludes patients from opportunities to receive care in the community, collectively pose challenges to wider implementation and sustainability.
PY - 2026
SN - 2949-8767 (Print); 2949-8759
SP - 210025
ST - Organizational perspectives on barriers and facilitators to an integrated care model for opioid use disorder and serious injection-related infections
T1 - Organizational perspectives on barriers and facilitators to an integrated care model for opioid use disorder and serious injection-related infections
T2 - J Subst Use Addict Treat
TI - Organizational perspectives on barriers and facilitators to an integrated care model for opioid use disorder and serious injection-related infections
U1 - Opioids & Substance Use
U3 - 10.1016/j.josat.2026.210025
VL - 189
VO - 2949-8767 (Print); 2949-8759
Y1 - 2026
ER -