Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA, 98108, USA.
Addict Sci Clin Pract. 2021 Sep 6;16(1):55. doi: 10.1186/s13722-021-00263-5.
Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers' perceptions about MOUD over the first year of implementation.
Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach.
Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents' ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time.
Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers' and clinical leaders' perceptions of MOUD over time. Strategies that improve leaders' prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.
改善阿片类药物使用障碍（MOUD）药物治疗的可及性是国家的重点，然而常见的可改变的障碍（例如，提供者知识有限、对 MOUD 的负面看法）经常对 MOUD 提供的实施构成挑战。为了解决这些障碍，VA 发起了一项多方面的实施干预措施，重点是规划和教育策略，以增加 18 个医疗设施中的 MOUD 治疗。本研究的目的是确定在 MOUD 实施的第一年，增加 MOUD 治疗的多方面干预方法是否改变了提供者对 MOUD 的看法。
来自初级保健、疼痛和心理健康诊所的跨学科临床医生团队收到了在干预启动前（基线）和 12 个月随访时完成匿名电子调查的邀请。使用描述性统计对回复进行总结，并使用调整了性别和处方状态的回归模型进行比较，并按设施进行聚类。对开放式问题的回复使用模板分析方法进行主题分析。
基线和随访时的调查回复率分别为 57.1%（56/98）和 50.4%（61/121）。在这两个时间点，大多数受访者都认为 MOUD 治疗很重要（94.7%比 86.9%）、拯救生命（92.8%比 88.5%）和基于证据（85.2%比 89.5%）。超过三分之一（37.5%）的人认为 MOUD 治疗很耗时，只有 53.7%的人在基线时表示诊所提供者愿意开 MOUD；随访时也有类似的反应（分别为 34.5%和 52.4%）。受访者对自己在阿片类药物使用障碍方面的知识、与患者讨论阿片类药物使用的舒适度、工作满意度、帮助阿片类药物使用障碍患者的能力以及同事的支持在两个时间点的评价都很好。受访者对 MOUD 治疗填补护理空白的评价很高，但从基线到随访显著下降（85.7%比 73.7%，p<0.04）。开放式回复确定了实施障碍，包括缺乏诊断和治疗阿片类药物使用障碍的支持以及缺乏时间。
尽管对 MOUD 的看法总体上是积极的，但有针对性的教育和规划策略并没有随着时间的推移改善提供者和临床领导者对 MOUD 的看法。提高领导者对 MOUD 的重视和支持，并解决与提供 MOUD 相关的时间限制的策略，可能会增加非物质使用治疗诊所获得 MOUD 的机会。
