Creating a plan for integrating medication-assisted treatment (MAT) in your ambulatory care setting can be an important first step in the implementation process, particularly for larger practices, organizations, or health systems. Having a clear plan can help keep you organized and motivated. Your plan should include a timeline and the set of tasks that need to be accomplished.
The services different practices or programs will be able to provide will vary. The extent of implementation planning needed may depend on the range of services that will be offered, the anticipated caseload of MAT patients, or the timeline for scaling up MAT services.
For instance, some small practices may not need an intensive process to start offering MAT services, but rather a provider obtains their waiver to prescribe buprenorphine and quickly integrates these visits into normal practice workflows. While many programs can benefit from thorough planning, medications to treat opioid use disorder can also be seen as one tool in a provider’s toolbox to help treat patients who need it.
Practices should have a clearly defined and mutually agreed-on plan to guide implementation of MAT for opioid use disorder.
How Do You Do It?
Identify Clinical Champions and the Implementation Planning Team
Identify clinical champions of MAT within the practice or organization. These champions may include program directors, physicians, nurse practitioners, physician’s assistants, or other office staff. Compassion for those with opioid use disorder and motivation to implement MAT may be more important qualities in a clinical champion than their official position within the organization.
Create a planning and implementation team for the clinical champions to lead. The team should have representatives from all staff roles to better understand how offering MAT services will affect the organization. Support from leadership, providers, and staff is essential to the success of a MAT program.
Depending on the size of your organization, several levels of leadership may affect the program’s success:
- Senior leadership can provide direction and communicate support for MAT services, as well as allocate resources needed for implementation.
- Midlevel leaders and administrators can help acquire resources and problem solve during implementation, particularly with issues that may emerge in larger multisite organizations.
- Frontline clinical leaders help staff adjust to changes in workflow and to solve day-to-day implementation problems.
Organize the Implementation Plan
The implementation team should develop a plan guided by the following questions:
- What is the local context? Know how the opioid epidemic is affecting your local community and those you serve. This information may include the prevalence of opioid misuse and opioid use disorder as well as opioid-related overdoses. Consider the treatment needs in the community and whether prescribing providers are sufficiently available. Assess the attitudes and policies toward MAT and opioid use disorder from other systems and organizations within the community, including the court system, hospitals or emergency departments, and acute care centers. Also, think about what other health issues or substance use disorders are affecting the community.
- What are your goals? Define the scope of the goals and objectives you seek to achieve.
- How will you define the clinical care team? Determine the roles and responsibilities of clinicians and other staff who will be on the care team.
- What resources will be required to implement the plan? Assess what resources you will need and what is available, including human, technological, and financial resources. For instance, practice coaches may be useful when implementing a substantial change, such as MAT. They can help guide the process and build internal resources to sustain the work over time.
- How will you communicate this plan to staff? For successful implementation, changes have to be clearly communicated to all staff. Your larger implementation plan should describe how you will communicate with staff to ease the transition. Promote staff engagement by inviting them to participate in this plan.
- How will you make this program sustainable? Long-term sustainability and stability of the program requires ongoing quality improvement, staff retention, and community support. Plan how you will finance MAT services, researching reimbursement rates and payment models in your State. Read more about these considerations in the sections on Quality Improvement, Strategies To Support Staff, and Financial Sustainability.
- How will you measure success? Determine what data you will collect and how they will be used to evaluate implementation efforts. For example, retention in treatment is probably the most important measure of success given the strong evidence linking retention and positive patient outcomes. Measures that should be considered will be discussed in greater detail in the sections on Patient Progress and Quality Improvement.
Design the Implementation Process
Once you have developed a plan, the team should develop a process for implementation. Consider how decisions will be made and how the process will be monitored. Establish a timeline to keep your organization on track. Your timeline should allow flexibility because unexpected factors may arise. Consider implementing MAT services in stages if needed.
What Not To Do
- Don’t include only senior leadership in the implementation planning process. Stakeholders from all levels of practice staff should be involved.