2045. The Opiate Agonist
Therapy Effectiveness Initiative: Baseline and Preliminary Outcome Results
ML Willenbring, Minneapolis VA Medical Center and University of Minnesota, HJ Hagedorn, Minneapolis VA Medical Center, AC Postier, Minneapolis VA Medical Center, M Kenny, Minneapolis VA Medical Center
Objectives: The OpiATE
Initiative is a facilitated quality improvement (FQI) initiative for VA opioid
agonist (methadone maintenance) clinics to implement four evidence-based
practices with demonstrated effectiveness for improving patient outcomes. The
four practices are: adequate dosing of agonist, maintenance orientation,
adequate counseling frequency, and use of contingency management.
participating programs were provided with the OpiATE Monitoring System (OMS)
which includes QI tools specific to each of the four target practices.
Participating programs receive a site visit from project staff for education on
research evidence supporting the specific practices and on implementing the QI
strategies. Following the site visit, project staff provide monthly data
analysis and feedback regarding practices, as well as monthly phone conferences
to support QI initiatives.
Data—All clinics were fully compliant with minimum counseling frequency
recommendations. Percentage of patients receiving doses of 60 mgs or more of
methadone ranged from 43% to 78% across clinics. Clinic median Abstinence
Orientation Scale (AOS) scores ranged from 1.9 to 3.1 on a scale of 1 to 5, with
higher scores reflecting less support for maintenance goals. Compliance with
contingency management recommendations was low. Progress to Date—The overall
percentage of patients receiving doses of 60 mgs or more of methadone has
improved from 60% to 64%. Feedback from clinics indicates that clinics are
revising policies regarding administrative discharge to reflect more maintenance
oriented practices and beginning to adopt policies consistent with principles of
contingency management. As the intervention and data collection continue over
the next six months, we expect continuing change in clinic practices and
improvement in patient outcomes.
of evidence based practices in complex interventions such as opioid agonist
therapy (OAT) is feasible, but requires relatively intensive support. Variation
of practices across clinics requires individualizing of the intervention to meet
each clinic's current needs. Attempts to implement such guidelines using
non-specific and non-intensive approaches alone are likely to fail.
Impact: Implementing best-practice guidelines in OAT has been shown to decrease illicit opioid use and increase clinic retention. Both of these outcomes are strongly predictive of longer term patient outcomes including remission of drug dependence and decreased mortality.