Spelman Juliette F, Edens Ellen L, Maya Susan, Moore Brent A, Boggs Angela, MacLean Robert R, Ackland Princess, Becker William C, Lynch Donna, Garcia-Vassallo Maria, Burgo Andrea L, Rosen Marc I, Gordon Adam J
is a Pr imary Care Physician; is an Addiction Psychiatrist and Substance Use Disorder Director, National TeleMental Health Center; is a Research Psychologist; is a Clinical Pharmacy Specialist in mental health (Clinical Resource Hub, Veterans Integrated Service Network 1); is a Clinical Psychologist; is a General Internist; is a Clinical Nurse Coordinator Outpatient Addiction; is an Addiction Psychiatrist; is a Primary Care Physician and National Co-Director for the Veterans Health Administration Primary Care Pain Initiative and Post Deployment Integrated Care Initiative; is an Addiction Psychiatrist and Director of Addiction Treatment programs; all at Veterans Affairs Connecticut Health Care System, in West Haven. is a Primary Care Physician at Beth Israel Deaconess Medical Center and an Instructor in Medicine at Harvard Medical School in Boston, Massachusetts. is an Investigator and Staff Psychologist at Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System and an Assistant Professor of Medicine at the University of Minnesota School of Medicine. is a Physician, Chief of Addiction Medicine, and Core Faculty at Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System and a Professor of Medicine and Psychiatry and Director of the Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine in Salt Lake City. Marc Rosen is a Professor of Psychiatry; Andrea Burgo is an Assistant Clinical Professor of Medicine; Maria Garcia-Vassallo is an Assistant Professor of Psychiatry; William Becker is an Associate Professor of Medicine; Robert MacLean is an Assistant Professor of Psychiatry; Ellen Edens is an Associate Professor of Psychiatry; Juliette Spelman is an Assistant Professor of Medicine; Brent Moore is a Research Scientist; all at Yale School of Medicine in New Haven.
Fed Pract. 2021 Oct;38(10):460-464. doi: 10.12788/fp.0186.
The opioid epidemic in the United States has generated a pressing need to enhance access to medications for opioid use disorder (MOUD). This program description illustrates a quality-improvement effort to extend MOUD to primary care and general mental health clinics within the US Department of Veterans Affairs (VA) Connecticut Healthcare system (VACHS), and to examine barriers and facilitators to implementation of MOUD in target clinics.
As part of the national VA Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative to improve MOUD access, a VACHS team identified and resolved barriers to MOUD in target clinics. Key interventions were to obtain leadership support, increase waivered prescribers, and develop processes and tools to enhance prescribing. New initiatives included quarterly educational sessions, templated progress notes, and instant messaging for addiction specialist electronic consultations. MOUD receipt and prescriber characteristics were evaluated before and 1 year after implementation. There was a 4% increase in eligible patients receiving MOUD, from 552 (44%) to 582 (48%) ( = .04). The number of waivered prescribers increased from 67 to 131, and the number of buprenorphine prescribers increased from 35 to 52 over a 6-month span, and the percentage of health care practitioners capable of prescribing within the electronic health record increased from 75% to 89% ( = .01).
An interdisciplinary team approach to identifying and overcoming barriers to MOUD target clinics expands access. Key interventions include interdisciplinary leadership engagement, proactive education and incentivization of target prescribers, removal of procedural barriers, and development of tools to facilitate and support prescribing. These concrete interventions can help inform other institutions interested in expanding MOUD access.
美国的阿片类药物泛滥引发了迫切需求，即要增加获得用于阿片类药物使用障碍（MOUD）治疗药物的机会。本项目描述展示了一项质量改进工作，旨在将MOUD扩展至美国退伍军人事务部（VA）康涅狄格医疗系统（VACHS）内的初级保健和普通精神健康诊所，并研究在目标诊所实施MOUD的障碍和促进因素。
作为VA全国阿片类药物使用障碍阶梯式护理培训培训师（SCOUTT）倡议的一部分，以改善MOUD的可及性，VACHS团队识别并解决了目标诊所中MOUD的障碍。关键干预措施包括获得领导层支持、增加获得豁免的处方医生数量，以及开发促进处方开具的流程和工具。新举措包括季度教育会议、模板化病程记录，以及用于成瘾专科医生电子会诊的即时通讯。在实施前和实施1年后对MOUD的接受情况和处方医生特征进行了评估。接受MOUD的符合条件患者增加了4%，从552人（44%）增至582人（48%）（P = 0.04）。在6个月的时间里，获得豁免的处方医生数量从67人增加到131人，丁丙诺啡处方医生数量从35人增加到52人，能够在电子健康记录系统中开具处方的医疗从业者比例从75%增至89%（P = 0.01）。
采用跨学科团队方法来识别和克服MOUD目标诊所的障碍可扩大可及性。关键干预措施包括跨学科领导层参与、对目标处方医生进行积极教育和激励、消除程序障碍，以及开发促进和支持处方开具的工具。这些具体干预措施可为其他有意扩大MOUD可及性的机构提供参考。
