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A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings
Spelman JF, Edens EL, Maya S, Moore BA, MacLean RR, Ackland PE, Becker WC, Lynch D, Garcia-Vassallo M, Burgo AL, Rosen MI, Gordon AJ. A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2021 Oct 14; 38(10):460-464.
Background: The opioid epidemic in the United States has
generated a pressing need to enhance access to medica%2tions for opioid use disorder (MOUD). This program descrip%2tion illustrates a quality-improvement effort to extend MOUD
to primary care and general mental health clinics within the
US Department of Veterans Affairs (VA) Connecticut Health,are system (VACHS), and to examine barriers and facilitators
to implementation of MOUD in target clinics.
Observations: As part of the national VA Stepped Care for
Opioid Use Disorder Train the Trainer (SCOUTT) initiative
to improve MOUD access, a VACHS team identified and
resolved barriers to MOUD in target clinics. Key interven%2tions were to obtain leadership support, increase waivered
prescribers, and develop processes and tools to enhance
prescribing. New initiatives included quarterly educational
sessions, templated progress notes, and instant messag%2ing for addiction specialist electronic consultations. MOUD
receipt and prescriber characteristics were evaluated be/ore and 1 year after implementation. There was a 4% in,rease in eligible patients receiving MOUD, from 552 (44%)
to 582 (48%) (P = .04). The number of waivered prescribers
increased from 67 to 131, and the number of buprenorphine
prescribers increased from 35 to 52 over a 6-month span, and
the percentage of health care practitioners capable of pre%2scribing within the electronic health record increased from
75% to 89% (P = .01).
Conclusions: An interdisciplinary team approach to identify%2ing and overcoming barriers to MOUD target clinics expands
access. Key interventions include interdisciplinary leadership
engagement, proactive education and incentivization of target
prescribers, removal of procedural barriers, and development
of tools to facilitate and support prescribing. These concrete
interventions can help inform other institutions interested in
expanding MOUD access.