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2019 HSR&D/QUERI National Conference Abstract

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1057 — Prescribing Outcomes over Six Months After Implementation of VA Stepped Care for Opioid Use Disorder Train-the-Trainer Initiative

Lead/Presenter: Eric Hawkins,  COIN - Seattle/Denver
All Authors: Hawkins EJ (Seattle-Denver COIN; Center of Excellence in Substance Addiction Treatment & Education; University of Washington), Malte C (Center of Excellence in Substance Addiction Treatment & Education), Williams E (Seattle-Denver COIN; University of Washington) Drexler K (Office of Mental Health and Suicide Prevention; Emory University) Hagedorn H (Minneapolis COIN; University of Minnesota) Gordon A (Salt Lake City COIN; University of Utah) Knoeppel J (Office of Mental Health and Suicide Prevention) Browne K (Center of Excellence in Substance Addiction Treatment & Education; University of Washington) Sayre G (Seattle-Denver COIN) Saxon A (Center of Excellence in Substance Addiction Treatment & Education; University of Washington)

Objectives:
Although rates of medication treatment of opioid use disorder (M-OUD) are increasing, less than 40% of Veterans Affairs (VA) patients with an OUD receive M-OUD. One VA program to address access to M-OUD is the national implementation of Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) Initiative, which uses cross-specialty implementation teams to disseminate M-OUD care across primary care, pain management and mental health clinics. SCOUTT launched in August 2018, with an in-person two-day meeting to train implementation teams at 18 VA facilities/VISNS to deliver M-OUD care using SCOUTT service-delivery models (e.g., Medical Management, Collaborative Care management) at their home clinics and spread care to other regional facilities. We report on M-OUD prescribing outcomes and barriers to prescribing over the initial six months of SCOUTT implementation.

Methods:
This prospective evaluation used information from SCOUTT implementation teams, SCOUTT facilitators and VA pharmacy data to identify M-OUD clinical activity and barriers in SCOUTT implementation clinics. Prescribing measures included numbers of patients with an OUD who are prescribed M-OUD and providers who prescribed M-OUD in implementation clinics, 90-day treatment retention, and percentage of implementation team prescribers who obtained DEA waivers and electronic keys to prescribe in VA (e-keys) and prescribed buprenorphine in month six.

Results:
The number of patients with an OUD who were prescribed buprenorphine in implementation clinics increased 66.7% (153-to-255) in the initial 6 months post SCOUTT launch; the number of providers prescribing buprenorphine increased 38.7% (31-to-43). Of 123 patients who started buprenorphine from 9/18-11/18, 70 (68.6%) received buprenorphine for > 90 days. Of 48 prescribers on original implementation teams, 87.5% have received DEA waivers, 68.8% have received e-keys and 60.4% prescribed buprenorphine. Delays in e-keys and prescribing at seven facilities were largely due to challenges with credentialing/privileging and low support from leadership and clinic staff.

Implications:
Numbers of patients with OUD receiving M-OUD and prescribers prescribing M-OUD have increased considerably over the initial six months of SCOUTT. Barriers to clinical/privileging and low support from leadership and clinic staff have delayed implementation efforts at some facilities.

Impacts:
Early results of this large implementation project suggest access to M-OUD care in VA can be improved.