Literature Collection

INTRODUCTION: Despite effective treatment for opioid use disorder, access to care is limited. Increased availability of evidence-based medication for opioid use disorder (MOUD) treatment within primary care is urgently needed. This study describes efforts to increase MOUD services within a large urban primary care practice. METHODS: After an internal assessment of barriers to MOUD services, a two-phase approach was used to educate providers and to implement MOUD services within a primary care practice over 2.5 years. Physicians became X-waiver certified in the education phase and completed four internal training sessions. Physicians completed pre-post surveys to assess their intention to prescribe MOUD. In the implementation phase, an interdisciplinary team designed accessible MOUD clinical hours. The RE-AIM model guided the evaluation of the MOUD training and services. The clinic evaluation included a medical records review, a provider focus group (n = 6), and patient interviews (n = 6). RESULTS: Pre-post surveys indicated that providers did not increase their intentions to prescribe MOUD. Once MOUD clinical hours were operational, the number of providers treating patients with MOUD increased substantially. Patients who received these services found them low-barrier, non-stigmatizing, and effective. The clinical team was satisfied with service delivery but offered suggestions for improvement for the whole primary care team. CONCLUSIONS: Increasing access to MOUD services within primary care may require iterative efforts to overcome practice-specific barriers, and gains may still be moderate. Training in MOUD services should focus on the whole primary care team as it requires interdisciplinary coordination to deliver high-quality services.

BACKGROUND: Qualitative methodologies offer a nuanced approach to understanding stakeholder perspectives, preferences, and context in implementation research. However, traditional qualitative data analysis can be time consuming and create barriers to responsive implementation of interventions. Rapid qualitative methods that yield timely, actionable results have emerged to expedite the evidence-to-practice gap, but often require all analysts to have implementation science expertise and resources for interview transcription. This study describes a novel rapid qualitative method to identify participant-driven social care recommendations in real time. METHODS: Caregivers of pediatric patients were enrolled onsite at two primary care clinics and one emergency department affiliated with a large urban pediatric healthcare system. A semi-structured interview guide was developed using the Health Equity Implementation Framework and Integrated Behavioral Model in partnership with multidisciplinary implementation stakeholders. Telephone interviews explored 60 caregivers' experiences with and perceptions of receiving social resources from healthcare. For traditional analysis, NVivo12 was used to code the first 10 verbatim transcripts to generate themes in an integrated inductive/deductive approach. In the rapid approach, a summary notes template designed to capture implementation-related data was completed immediately following the same 10 interviews. A secondary analyst used the templates to create participant-level summaries and identify implementation-related themes. Themes found in each method were quantified and mapped onto each other using an analytic matrix to compare the number and consistency of themes. RESULTS: Themes generated in both methods mapped consistently onto each other; 92.8% of themes found in traditional analysis were accounted for within our rapid method. The quantity of themes was similar between the two methods: the traditional approach generated 69 themes and 22 subthemes, while our rapid approach generated 72 themes and 21 subthemes. CONCLUSIONS: Our interview notes-based rapid qualitative method was successful in producing themes consistent with the traditional approach in both content and quantity. This approach is also pragmatic, as it does not require analysts to have deep implementation science expertise and saves transcription costs. By balancing rigor with time to actionable results, this rapid method provides a tool for implementation researchers to generate qualitative findings on an accelerated timeline to inform policy and practice. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, #NCT05251311, https://www. CLINICALTRIALS: gov/study/NCT05251311 , on September 30, 2021.