Green Brandn, Rhubart Danielle Christine, Filteau Matthew R
JG Research and Evaluation, Bozeman, MT, USA.
Department of Biobehavioral health, The Pennsylvania State University, University Park, PA, USA.
Subst Abuse. 2021 Aug 30;15:11782218211039781. doi: 10.1177/11782218211039781. eCollection 2021.
Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana.
The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts.
Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization.
This case study identified limits to the H&S model utility in supporting states' abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.
阿片类药物使用障碍（MOUD）的药物获取情况在城乡连续体中存在差异。中心-辐条模式（H&S）应运而生，以解决这些服务差距，即拥有MOUD专业人员的中心为通常位于劳动力短缺的农村社区的一系列辐条地点网络提供专科护理。本文介绍了在一个边疆和农村（FAR）州——蒙大拿州实施中心-辐条模式的案例研究。
主要数据是对蒙大拿州中心和辐条地点的65名MOUD项目工作人员进行的结构化访谈。采用归纳编码和演绎编码对访谈记录进行分析。
利用H&S结构在蒙大拿州扩大MOUD的获取导致了喜忧参半的结果。访谈中确定了一些关于中心难以成功招募辐条地点的一致主题，包括（1）地理障碍，（2）医疗服务提供者缺乏兴趣，（3）对需求过多的担忧，（4）对该模式财务可行性的担忧，以及（5）倾向于非正式技术援助而非正式的H&S关系。除了这5个主题外，在不同医疗系统中实施H&S的努力未成功，而当H&S地点在同一组织内时，H&S模式效果更佳。
本案例研究确定了H&S模式在支持各州扩大MOUD治疗获取能力方面的效用限制，并提出了使其适应不同农村环境差异的建议。我们最后提出了一些策略建议，这些策略可能有助于在像蒙大拿州那样的农村社区扩大MOUD。
