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Author Notes:

Eric J. Hawkins, Email: eric.hawkins@va.gov

EH, AD, and CM contributed to the study design, data collection, data analyses, data interpretation and drafting and/or revising the manuscript for publication. EW, HH, AG, KD, JB, JK, AL, AS, and GS contributed to the study design, data interpretation and revising the manuscript for publication. AM and BB contributed to data interpretation and revising the manuscript for publication. All authors read and approved the final manuscript.

Dr. Saxon reports personal fees from Indivior and consulting fees and travel support from Alkermes, outside the submitted work. Dr. Gordon reports an honorarium from UpToDate, Inc. and serves on the board of directors for the American Society of Addiction Medicine, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, and the International Society of Addiction, all organizations that are not-for-profit. All other authors declare that they have no competing interests.

Subjects:

Research Funding:

This work was supported by the U.S. Department of Veterans Affairs (VA), Office of Mental Health and Suicide Prevention, Veterans Health Administration, the VA Center of Excellence in Substance Addiction Treatment and Education, the VA Health Services Research and Development (HSR&D) Quality Enhancement Research Initiative Partnered Evaluation Initiative (PEC) # 18–203. Supporting organizations had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Keywords:

  • Barriers
  • Buprenorphine
  • Facilitators
  • Implementation
  • Mental health
  • Opioid use disorder
  • Primary care
  • Buprenorphine
  • Humans
  • Opioid-Related Disorders
  • Primary Health Care
  • Veterans

Clinical leaders and providers’ perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs’ facilities

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Journal Title:

Addiction Science and Clinical Practice

Volume:

Volume 16, Number 1

Publisher:

, Pages 55-55

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Copyright information:

© The Author(s) 2021

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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