Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA.
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA 02453, USA.
J Subst Abuse Treat. 2020 Jan;108:33-39. doi: 10.1016/j.jsat.2019.07.007. Epub 2019 Jul 19.
The federal Opioid State Targeted Response (Opioid STR) grants provided funding to each state to ramp up the range of responses to reverse the ongoing opioid crisis in the U.S. Washington State used these funds to develop and implement an integrated care model to expand access to medication treatment and reduce unmet need for people with opioid use disorders (OUD), regardless of how they enter the treatment system. This paper examines the design, early implementation and results of the Washington State Hub and Spoke Model.
Descriptive data were gathered from key informants, document review, and aggregate data reported by hubs and spokes to Washington State's Opioid STR team.
The Washington State Hub and Spoke Model reflects a flexible approach that incorporates primary care and substance use treatment programs, as well as outreach, referral and social service organizations, and a nurse care manager. Hubs could be any type of program that had the required expertise and capacity to lead their network in medication treatment for OUD, including all three FDA-approved medications. Six hub-spoke networks were funded, with 8 unique agencies on average, and multiple sites. About 150 prescribers are in these networks (25 on average). In the first 18 months, nearly 5000 people were inducted onto OUD medication treatment: 73% on buprenorphine, 19% on methadone, and 9% on naltrexone.
The Washington State Hub and Spoke Model built on prior approaches to improve the delivery system for OUD medication treatment and support services, by increasing integration of care, ensuring "no wrong door," engaging with community agencies, and supporting providers who are offering medication treatment. It used essential elements from existing integrated care OUD treatment models, but allowed for organic restructuring to meet the population needs within a community. To date, there have been challenges and successes, but with this approach, Washington State has provided medication treatment for OUD to nearly 5000 people. Sustainability efforts are underway. In the face of the ongoing opioid crisis, it remains essential to develop, implement and evaluate novel models, such as Washington's Hub and Spoke approach, to improve treatment access and increase capacity.
联邦阿片类药物州目标响应（Opioid STR）拨款为每个州提供资金，以扩大应对范围，扭转美国目前的阿片类药物危机。华盛顿州利用这些资金开发并实施了一种综合护理模式，以扩大药物治疗的可及性，并减少有阿片类药物使用障碍（OUD）的人的未满足需求，无论他们如何进入治疗系统。本文探讨了华盛顿州中心辐射模式的设计、早期实施和结果。
从关键知情人、文件审查和中心和辐射点向华盛顿州阿片类药物 STR 团队报告的汇总数据中收集描述性数据。
华盛顿州中心辐射模型反映了一种灵活的方法，其中包括初级保健和药物滥用治疗计划，以及外展、转介和社会服务组织，以及一名护士护理经理。中心可以是任何具有领导 OUD 药物治疗所需专业知识和能力的项目，包括所有三种经 FDA 批准的药物。六个中心辐射网络获得了资金，平均每个网络有 8 个独特的机构和多个地点。大约 150 名处方者在这些网络中（平均 25 名）。在最初的 18 个月里，近 5000 人接受了 OUD 药物治疗：73%的人使用丁丙诺啡，19%的人使用美沙酮，9%的人使用纳曲酮。
华盛顿州中心辐射模型在先前改善 OUD 药物治疗和支持服务提供系统的方法基础上，通过增加护理的整合、确保“没有错误的门”、与社区机构合作以及支持提供药物治疗的提供者，进一步改进了方法。它利用了现有的综合护理 OUD 治疗模型的基本要素，但允许进行有机重组，以满足社区内的人口需求。迄今为止，该方法取得了一些挑战和成功，但通过这种方法，华盛顿州已经为近 5000 人提供了 OUD 药物治疗。可持续性工作正在进行中。面对持续的阿片类药物危机，开发、实施和评估新的模式仍然至关重要，例如华盛顿州的中心辐射方法，以改善治疗可及性并提高能力。
