"The Only Reason I Am Willing to Do It at All": Evaluation of VA's SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-29 DOI:10.1097/ADM.0000000000001277

Emily C Williams, Madeline C Frost, Anissa N Danner, Aline M K Lott, Carol E Achtmeyer, Carly L Hood, Carol A Malte, Andrew J Saxon, Eric J Hawkins

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引用次数: 0

Abstract

Objectives: Medication treatment for opioid use disorder (MOUD) is effective and recommended for outpatient settings. We implemented and evaluated the SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center-a quality improvement partnership to implement stepped care for MOUD in 2 Veterans Health Administration (VA) primary care (PC) clinics.

Methods: SUPPORT provided a dedicated clinical team (nurse practitioner prescriber and social worker) and stepped care ([1] identification, assessment, referral; [2] MOUD induction; [3] stabilization; and [4] maintenance supporting PC providers [PCPs] to initiate and/or sustain treatment) coupled with ongoing internal facilitation (consultation, trainings, informatics support). Qualitative interviews with stakeholders (PCPs and patients) and meeting notes identified barriers and facilitators to implementation. Electronic health record and patient tracking data measured reach, adoption, and implementation outcomes descriptively.

Results: SUPPORT's implementation barriers included the need for an X-waiver, VA's opioid tapering policies, patient and PCP knowledge gaps and PCP discomfort, and logistical compatibility and sustainability challenges for clinics. SUPPORT's dedicated clinical staff, ongoing internal facilitation, and high patient and PCP satisfaction were key facilitators. SUPPORT (January 2019 to September 2021) trained 218 providers; 63 received X-waivers, and 23 provided MOUD (10.5% of those trained). SUPPORT provided care to 167 patients, initiated MOUD for 33, and provided education and naloxone to 72 (all = 0 in year before launch).

Conclusions: SUPPORT reached many PCPs and patients and resulted in small increases in MOUD prescribing and high levels of stakeholder satisfaction. Dedicated clinical staff was key to observed successes. Although resource-intensive, SUPPORT offers a potential model for outpatient MOUD provision.

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"我愿意这么做的唯一原因"：退伍军人事务部 "支持初级保健提供者降低阿片类药物风险和治疗（SUPPORT）中心 "评估。

目标：阿片类药物使用障碍（MOUD）的药物治疗是有效的，建议在门诊环境中使用。我们在退伍军人健康管理局（VA）的两家初级保健（PC）诊所实施并评估了 "支持初级保健提供者降低阿片类药物风险和治疗（SUPPORT）中心"--一种实施阿片类药物使用障碍阶梯式治疗的质量改进合作项目：SUPPORT 提供了一个专门的临床团队（开处方的执业护士和社工）和阶梯式护理（[1] 识别、评估、转诊；[2] MOUD 诱导；[3] 稳定；[4] 维护，支持 PC 提供者 [PCPs] 启动和/或维持治疗），并持续提供内部促进（咨询、培训、信息支持）。对利益相关者（初级保健医生和患者）的定性访谈和会议记录确定了实施过程中的障碍和促进因素。电子健康记录和患者跟踪数据以描述性方式衡量了覆盖范围、采用情况和实施结果：SUPPORT 的实施障碍包括需要 X 豁免、退伍军人事务部的阿片类药物减量政策、患者和初级保健医生的知识差距和初级保健医生的不适感，以及诊所的后勤兼容性和可持续性挑战。SUPPORT 的专职临床人员、持续的内部促进以及患者和初级保健医生的高满意度是关键的促进因素。SUPPORT 计划（2019 年 1 月至 2021 年 9 月）培训了 218 名医疗服务提供者；63 人获得了 X 级豁免，23 人提供了 MOUD（占受训人数的 10.5%）。SUPPORT 为 167 名患者提供了护理服务，为 33 名患者启动了 MOUD，并为 72 名患者提供了教育和纳洛酮（启动前一年的所有人数 = 0）：结论："支持计划 "惠及了许多初级保健医生和患者，使 MOUD 的处方量略有增加，利益相关者的满意度很高。专职临床人员是取得成功的关键。尽管需要大量资源，但 SUPPORT 为门诊 MOUD 的提供提供了一个潜在的模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.