2045. The Opiate Agonist Therapy Effectiveness Initiative: Baseline and Preliminary Outcome Results
ML Willenbring, Minneapolis VA Medical Center and University of Minnesota, HJ Hagedorn, Minneapolis VA Medical Center, AC Postier, Minneapolis VA Medical Center, M Kenny, Minneapolis VA Medical Center

Objectives: The OpiATE Initiative is a facilitated quality improvement (FQI) initiative for VA opioid agonist (methadone maintenance) clinics to implement four evidence-based practices with demonstrated effectiveness for improving patient outcomes. The four practices are: adequate dosing of agonist, maintenance orientation, adequate counseling frequency, and use of contingency management.

Methods: Nine participating programs were provided with the OpiATE Monitoring System (OMS) which includes QI tools specific to each of the four target practices. Participating programs receive a site visit from project staff for education on research evidence supporting the specific practices and on implementing the QI strategies. Following the site visit, project staff provide monthly data analysis and feedback regarding practices, as well as monthly phone conferences to support QI initiatives.

Results: Baseline Data—All clinics were fully compliant with minimum counseling frequency recommendations. Percentage of patients receiving doses of 60 mgs or more of methadone ranged from 43% to 78% across clinics. Clinic median Abstinence Orientation Scale (AOS) scores ranged from 1.9 to 3.1 on a scale of 1 to 5, with higher scores reflecting less support for maintenance goals. Compliance with contingency management recommendations was low. Progress to Date—The overall percentage of patients receiving doses of 60 mgs or more of methadone has improved from 60% to 64%. Feedback from clinics indicates that clinics are revising policies regarding administrative discharge to reflect more maintenance oriented practices and beginning to adopt policies consistent with principles of contingency management. As the intervention and data collection continue over the next six months, we expect continuing change in clinic practices and improvement in patient outcomes.

Conclusions: Implementation of evidence based practices in complex interventions such as opioid agonist therapy (OAT) is feasible, but requires relatively intensive support. Variation of practices across clinics requires individualizing of the intervention to meet each clinic's current needs. Attempts to implement such guidelines using non-specific and non-intensive approaches alone are likely to fail.

Impact: Implementing best-practice guidelines in OAT has been shown to decrease illicit opioid use and increase clinic retention. Both of these outcomes are strongly predictive of longer term patient outcomes including remission of drug dependence and decreased mortality.