4055 — Evaluation of a Hybrid Type III Implementation Trial of an Interdisciplinary Clinic to Address Unsafe Use of Opioids for Veterans with Chronic Pain

Lead/Presenter: Sara Edmond ,  PRIME Center
All Authors: Midboe AM (VA Palo Alto Healthcare System, Menlo Park, CA and Stanford University School of Medicine, Stanford, CA), Perez T (VA Palo Alto Healthcare System, Menlo Park, CA) Cave S (VA Palo Alto Healthcare System, Menlo Park, CA) Edmond SN (Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, Yale School of Medicine, New Haven, CT) Becker WC ((Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, Yale School of Medicine, New Haven, CT)

Objectives:
While opioid overdose deaths continue to climb, chronic pain remains prevalent with approximately 20% of Americans living with this disorder. Preventing overdose deaths and supporting the unique needs of patients who are living with chronic pain requires not only evidence-based treatments options but improving access to them through implementation science. The Opioid Reassessment Clinic (ORC) model relies on a multidisciplinary team applying evidence-based practices in the treatment of those living with chronic pain and complex psychiatric comorbidities. The ORC model is integrated within primary care, with the objective of providing longitudinal co-management of pain and opioid use disorder while promoting engagement in non-pharmacological pain treatments (NPTs). As part of a hybrid type III trial, we evaluated the effect of Implementation Facilitation (IF) on the implementation of an ORC at three Veterans Health Administration (VHA) sites.

Methods:
This mixed-methods evaluation relied on the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM framework to evaluate the use of Implementation Facilitation across 18 months to implement an ORC at 3 VHA sites in different regions of the United States. We used administrative data and information tracked during site facilitation meetings to evaluate our approach.

Results:
Initial analyses reveal that 532 patients living with chronic pain and psychiatric comorbidities (81-91% of patients) were treated across 3 sites. A total of 127 providers adopted the ORC or were trained on the model. Reductions in morphine equivalent daily doses (MEDD) have ranged from 34% to 75% decrease in MEDD at sites. Prescribing of buprenorphine, a safer alternative to full agonist opioids, has increased significantly alongside referrals to NPTs. A formative qualitative evaluation revealed several relevant CFIR-related determinants for tailoring of IF and informing future dissemination efforts.

Implications:
At three VHA implementation sites, Implementation Facilitation was an effective implementation strategy to improve care for Veterans living with chronic pain and complex psychiatric comorbidities.

Impacts:
This hybrid type III trial using Implementation Facilitation at three VHA sites led to over 500 Veterans with chronic receiving care from an ORC over an 18-month period; preliminary analysis of administrative data suggests improvements in opioid safety as a result of patient engagement with the ORC.