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2015 HSR&D/QUERI National Conference Abstract

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3177 — Formative Evaluation of Life-Saving Opioid Overdose Education and Naloxone Distribution (OEND) in VISNs 10 and 21

Oliva EM, VA Center for Innovation to Implementation; McCaa MD, VA Center for Innovation to Implementation; Lewis ET, VA Center for Innovation to Implementation; Cochran MF, VA Palo Alto Health Care System and Stanford University, Department of Psychiatry and Behavioral Sciences--Psychopharmacology; Konicki PE, Louis Stokes Cleveland VA Medical Center; Wilder CM, Cincinnati VA Medical Center and University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience;

Objectives:
To prevent opioid overdose mortality, pilot programs of Opioid Overdose Education and Naloxone Distribution (OEND) began in 2013 and a national program began in 2014. This study evaluates VA OEND implementation among early adopters in VISNs 10 and 21. Study objectives are to: (1) identify barriers and facilitators of early OEND implementation and (2) use information gathered to improve future OEND implementation.

Methods:
We conducted four focus groups comprising 21 patients total in VISN 21 along with 39 stakeholder telephone interviews with VA staff in VISNs 10 and 21 (9 frontline staff; 19 OEND champions; 11 leaders). Following Stetler et al.'s (2011) revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework for implementation, our formative evaluation defined Successful Implementation (SI) as a function of Evidence and Evidence-Based Practice (EBP) Characteristics (E), Contextual Readiness for Targeted EBP Implementation (C), and Facilitation (F). Thematic coding of the interviews and focus groups identified facilitators and barriers of OEND implementation.

Results:
Preliminary qualitative analyses revealed that most barriers and facilitators of Successful Implementation related to Contextual Readiness. Programs with strong leadership support and broad-based, effective collaborations experienced the most expansion and overall program success. We identified (1) other VA initiatives or programs competing for time, workspace, and staff; and (2) complications working with local pharmacies as the major barriers to implementation among early adopters. However, pharmacy leadership support and approved protocols helped resolve pharmacy-related barriers. Patients and staff agreed on the need for OEND--as expressed by one patient, "One summer, seven of my friends died [from overdose]"¦.I couldn't help thinking that if this was available back then, you know, it couldn't have happened ["¦] it's the only thing that can really stop the overdose."

Implications:
Because most barriers and facilitators of OEND implementation related to Contextual Readiness, future OEND implementation should focus on enhancing leadership support and collaborations with pharmacy, and ensuring that OEND implementation is adequately resourced.

Impacts:
OEND is a cost-effective intervention that could reduce opioid-related mortality among Veterans. Understanding factors involved in successful implementation will inform and improve national adoption of this life-saving intervention.