University of Louisville, Kent School of Social Work & Family Science, 2217 S 3rd St, Louisville, KY, USA.
University of Chicago, Crown Family School of Social Work, Policy, and Practice, 969 East 60th Street, Chicago, IL, USA.
J Subst Use Addict Treat. 2023 Nov;154:209157. doi: 10.1016/j.josat.2023.209157. Epub 2023 Aug 29.
The COVID-19 pandemic has had devasting effects on drug abuse treatment systems already stressed by the opioid crisis. Providers within opioid use disorder (OUD) outpatient treatment programs have had to adjust to rapid change and respond to new service delivery provisions such as telehealth and take-home medication. Using the COVID-19 pandemic and subsequent organizational challenges as a backdrop, this study explores providers' perspectives about strategies and policies that, if made permanent, can potentially improve access to and quality of OUD treatment.
This qualitative study was conducted in Los Angeles County, which has one of the largest substance use disorder (SUD) treatment systems in the United States serving a diverse population, including communities impacted by the opioid crisis. We collected qualitative interview data from 30 high-performing programs (one manager/supervisor per program) where we based high performance on empirical measures of access, retention, and program completion outcomes. The study team completed data collection and analysis using constructivist grounded theory (CGT) to describe the social processes in which the participating managers engaged when faced with the pandemic and subsequent organizational changes. We developed 14 major codes and six minor codes with definitions. The interrater reliability tests showed pooled Cohen's kappa statistic of 93 %.
Our results document the impacts of COVID-19 on SUD treatment systems, their programmatic responses, and the strategic innovations they developed to improve service delivery and quality and which managers plan to sustain within their organizations.
Providers identified three primary areas for strategic innovation designed to improve access and quality: (1) designing better medication utilization, (2) increasing telemedicine capacity, and (3) improving reimbursement policies. These strategies for system transformation enable us to use lessons from the COVID-19 pandemic to direct policy and programmatic reform, such as expanding eligibility for take-home medication and enhancing access to telehealth services.
COVID-19 大流行对已经受到阿片类药物危机压力的药物滥用治疗系统造成了毁灭性的影响。阿片类药物使用障碍（OUD）门诊治疗项目的提供者不得不快速调整，以适应新的服务提供规定，如远程医疗和带药回家。本研究以 COVID-19 大流行及随后的组织挑战为背景，探讨提供者对潜在改善 OUD 治疗的获得和质量的策略和政策的看法，如果这些策略和政策永久化。
这项定性研究在洛杉矶县进行，该县拥有美国最大的物质使用障碍（SUD）治疗系统之一，为包括受阿片类药物危机影响的社区在内的多样化人群提供服务。我们从 30 个表现出色的项目（每个项目一名经理/主管）中收集了定性访谈数据，这些项目的表现出色是基于获得、保留和项目完成结果的经验衡量标准。研究小组使用建构主义扎根理论（CGT）完成数据收集和分析，以描述参与管理人员在面临大流行和随后的组织变革时所参与的社会过程。我们制定了 14 个主要代码和 6 个次要代码，并对其进行了定义。组内信度检验表明， pooled Cohen's kappa 统计值为 93%。
我们的研究结果记录了 COVID-19 对 SUD 治疗系统、其计划方案以及他们为改善服务提供和质量而开发的战略创新的影响，管理人员计划在其组织内维持这些创新。
提供者确定了三个旨在改善获得和质量的战略创新领域：（1）设计更好的药物利用，（2）增加远程医疗能力，（3）改善报销政策。这些系统转型策略使我们能够利用 COVID-19 大流行的经验教训来指导政策和项目改革，例如扩大带药回家的资格和增强远程医疗服务的获得。
