QUERI – Quality Enhancement Research Initiative

Improving Access to Opioid Use Disorder Treatment in Primary Care Settings

Salt Lake City, UT

Overview

Among Veterans receiving VA healthcare, there has been a sharp rise in the number of patients diagnosed with opioid use disorder (OUD): from 25,031 in 2003 to 69,142 in 2017. As the largest provider of substance use disorder treatment in the nation, VA continues to be proactive in increasing access to medications indicated for OUD, an essential component of evidence-based care. However, as a recent HSR&D-funded study suggests, substantial challenges persist, such as the underuse of medications, a wide variability in prescribing rates, and the capacity to supply methadone, which all requires further research.¹  Moreover, a recent systematic review  suggests that multidisciplinary and coordinated care delivery models are an effective strategy to implement OUD treatment and increase access to medication-assisted treatment in primary care, but research directly comparing specific structures and processes of care models is still needed.²

The primary objective of the Implementation and Evaluation of a Multifaceted Provider Support Initiative to Improve Access to Opioid Use Disorder Treatment in Primary Care Settings QUERI National Partnered Evaluation is to implement and evaluate the evidence-based, effective practice of medication treatment of opioid use disorder in primary care settings. Specifically, investigators will:

• Evaluate the implementation and impact of a multifaceted provider support initiative at two VA medical centers and four community-based clinics in VISN19.
  • The multi-faceted initiative will leverage existing VA and VISN resources (including e-consults, tele-mentoring and telehealth) to facilitate improved access to OUD treatment in primary care.
• Create an interactive implementation toolkit with guidance on facilitation and incentive strategies and resources for broader dissemination across the VISN and VA.

1. Wyse J, Gordon A, Dobscha S, et al. Medications for opioid use disorder in the Department of Veterans Affairs (VA) healthcare system: Historical perspective, lessons learned, and next steps. Substance Abuse. 2018;39(2):139-144.
2. Laqisetty P, Klasa K, Bush C, et al. Primary care models for treatment opioid use disorders: What actually works? A systematic review. PLoS One. October 2017;17(12):e0186315.

Methodology

Investigators will use the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) implementation framework to evaluate the implementation and impact of the multifaceted provider support initiative. The i-PARIHS model provides investigators with information on the characteristics associated with positive facilitation of the initiative and helps identify important factors that need addressing as part of the facilitation strategy. This model also provides key insights on facilitator roles during different phases of the initiative.

Potential Impacts

The project will improve treatment access for Veterans with opioid use disorder by supporting treatment in primary care settings, and building on Veterans’ relationships with primary care teams to provide Veteran-centered, team-based OUD treatment

Principal Investigator: Adam Gordon, MD, MPH, is a former HSR&D Career Development Awardee, and is Chief of Addiction Medicine at the VA Salt Lake City Health Care System.

Operational Partners: VISN19, Rocky Mountain VA Network.