University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Int J Drug Policy. 2024 Nov;133:104569. doi: 10.1016/j.drugpo.2024.104569. Epub 2024 Sep 5.
Rates of fatal overdose continue to rise in the United States, and most people with opioid use disorder (OUD) are not engaged in evidence-based treatment with medications. In Philadelphia, a city with one of the highest fatal overdose rates in the country, many residents face significant care access barriers. The COVID-19 pandemic - which destabilized the street drug supply and forced many clinics to limit services - worsened this crisis, but also led to regulatory changes that allowed for buprenorphine induction and maintenance visits via telehealth in the U.S. To increase access to buprenorphine across the Philadelphia area and reach individuals who struggle to access care, Penn Medicine developed the CareConnect Warmline in October 2021. CareConnect is embedded in an existing virtual urgent care practice. Staffed by advanced practice providers and substance use navigators (SUNs), CareConnect provides same-day buprenorphine bridge (i.e., short-term) prescriptions and linkage to longitudinal OUD care.
To examine barriers and facilitators to implementing CareConnect from the perspective of key stakeholders, including CareConnect leadership, clinicians, and staff, and attitudes and beliefs about providing care for patients with OUD via this model.
In this qualitative descriptive study, we interviewed 14 participants and used thematic analysis to analyze the data. The sample included CareConnect prescribing clinicians, SUNs, and administrative staff.
Our analysis yielded four themes: 1/ CareConnect is a unique program that fills an important care gap; 2/ Benefits of leveraging existing infrastructure; 3/ Importance of an interdisciplinary team; and 4/ Necessity of relationships with outside stakeholders. Prescribing clinicians and administrative staff - most of whom had little experience with OUD care before CareConnect - stressed how embedding the model within an existing virtual clinic and involving experienced SUNs increased their comfort prescribing buprenorphine. However, all participants highlighted how the program's effectiveness is contingent upon buy-in from outside stakeholders, including pharmacists who fill the prescriptions and longitudinal care providers in the community.
Innovative delivery models can help expand OUD care access to individuals who are poorly served by traditional treatment infrastructure. Our findings provide valuable insight to improve and sustain CareConnect and can guide the development and implementation of future programs nationally.
在美国，致命过量用药的比率持续上升，大多数患有阿片类药物使用障碍（OUD）的人并未接受基于药物的循证治疗。在费城，这个城市的致命过量用药率位居全美前列，许多居民面临着严重的医疗服务获取障碍。COVID-19 大流行——破坏了街头毒品供应并迫使许多诊所限制服务——使这场危机恶化，但也导致了监管变革，允许美国通过远程医疗进行丁丙诺啡诱导和维持治疗。为了增加整个费城地区的丁丙诺啡获取途径，并接触到难以获得护理的个体，宾夕法尼亚大学医学部于 2021 年 10 月推出了 CareConnect 热线。CareConnect 嵌入在现有的虚拟紧急护理实践中。CareConnect 由高级实践提供者和物质使用导航员（SUN）组成，提供当天的丁丙诺啡桥接（即短期）处方，并与纵向 OUD 护理联系起来。
从关键利益相关者的角度，包括 CareConnect 领导层、临床医生和工作人员，以及通过这种模式为 OUD 患者提供护理的态度和信念，来研究实施 CareConnect 的障碍和促进因素。
在这项定性描述性研究中，我们采访了 14 名参与者，并使用主题分析对数据进行分析。样本包括 CareConnect 处方临床医生、SUN 和行政人员。
我们的分析产生了四个主题：1. CareConnect 是一个独特的项目，填补了重要的护理空白；2. 利用现有基础设施的好处；3. 跨学科团队的重要性；4. 与外部利益相关者建立关系的必要性。处方临床医生和行政人员——他们中的大多数人在 CareConnect 之前几乎没有 OUD 护理经验——强调了将该模式嵌入现有的虚拟诊所并涉及经验丰富的 SUN 如何增加他们开丁丙诺啡的舒适度。然而，所有参与者都强调了该计划的有效性取决于外部利益相关者的支持，包括配药的药剂师和社区中的纵向护理提供者。
创新的交付模式可以帮助扩大 OUD 护理的获取途径，使那些传统治疗基础设施服务不足的个体受益。我们的研究结果为改善和维持 CareConnect 提供了有价值的见解，并可以为全国范围内未来项目的开发和实施提供指导。
