2019 HSR&D/QUERI National Conference
4032 — Advancing Pharmacological Treatment for Opioid Use Disorders (ADaPT-OUD): Barriers and Facilitators During Early Implementation
Lead/Presenter: Hildi Hagedorn, COIN - Minneapolis
All Authors: Hagedorn HJ (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS; University of Minnesota School of Medicine), Kenny ME (Center for Chronic Disease Outcomes Research, Minneapolis VAHCS), Ackland P (Center for Chronic Disease Outcomes Research, Minneapolis VAHCS; University of Minnesota School of Medicine) Salameh H (Center for Chronic Disease Outcomes Research, Minneapolis VAHCS) Gordon AJ (Salt Lake City VAHCS; University of Utah School of Medicine)
Improving Veteran access to medication treatment for opioid use disorder (M-OUD) is a national VA priority. VA operations' efforts to enhance access to M-OUD has increased the number of patients receiving this therapy nationally. However, many facilities remain low-adopters. Eight low-adopter sites were recruited to receive intensive external facilitation. Four sites have received the intervention for at least 6 months. We sought to examine the initial barriers and facilitators of M-OUD implementation in these low-adopting facilities.
Eight VA sites were randomly selected from sites with low M-OUD prescribing rates ( < 21%) to receive the intervention. The intervention includes a site-specific developmental evaluation, a kick-off site visit with goal-setting, and 12 months of facilitation calls. Pre-implementation interviews and facilitation meeting notes were rapidly analyzed using matrices to identify barriers and facilitators across sites using i-PARIHS constructs (Innovation, Recipients, Context).
Few facilities were able to accomplish action plan goals within the first 6 months of the intervention. Perceptions of the innovation (M-OUD) was not a common barrier; however, occasionally M-OUD did not fit with providers' existing values regarding OUD treatment. Recipients (providers) did not have adequate training in M-OUD, had misconceptions about OUD and its treatment, and did not feel they could prescribe without ample nursing and/or pharmacy support. Implementation of M-OUD outside of substance use disorder specialty care did not fit with the existing clinical context, e.g., siloed care, lack of fully functional interdisciplinary teams. Facilitators included leadership support, the strong push within and outside VA to address OUD, and on-site clinical expertise.
While training and education are essential to improving access to M-OUD, changes in policies, clinic structure, and cross-clinic communication are also required. Having an experienced provider available to provide mentorship is a key facilitator to building confidence in practice change.
Early results indicate implementing M-OUD requires more than 6 months and more than acquiring skills and knowledge. Access to experienced mentors is helpful to achieve change.