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2019 HSR&D/QUERI National Conference Abstract

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1123 — Advancing Pharmacological Treatment for Opioid Use Disorder (ADaPT-OUD): Implementation Phase

Lead/Presenter: Hilldi Hagedorn,  COIN - Minneapolis
All Authors: Hagedorn HJ (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS; University of Minnesota School of Medicine), Kenny ME (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS), Clothier B (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS) Bangerter A (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS) Noorbaloochi S (Center for Care Delivery and Outcomes Research, Minneapolis VAHCS; University of Minnesota School of Medicine) Gordon AJ (Salt Lake City VAHCS; University of Utah School of Medicine)

Objectives:
Given the rise in opioid use disorder (OUD) and overdose, increasing Veteran access to medication addiction treatment for OUD (M-OUD) is a VA priority. However, expansion of M-OUD in many VA facilities is limited. We report on the interim progress of four facilities enrolled in an external facilitation intervention to improve M-OUD implementation.

Methods:
Eight VA sites were randomly selected from sites with low M-OUD prescribing rates ( < 21%) to receive the intervention which consisted of a developmental evaluation, a site visit, and twelve monthly facilitation calls. These sites were matched to other low adopter sites (4-5 sites/intervention site) and compared on three outcomes (number of buprenorphine waivered prescribers; number of patients prescribed buprenorphine; percent of patients with OUD receiving M-OUD) at baseline and 6 months post-intervention kick-off.

Results:
Of the eight sites enrolled, four selected sites have received the intervention for at least 6 months. At baseline, three of the four intervention sites had only one waivered provider and prescribed to three patients total (range: 0-2). Within six months, these sites added multiple waivered providers (range: 4-8) and prescribed to 53 patients total (range: 9-27). The percent increase on both variables was greater than matched controls for these sites. The fourth site started with more providers (5) and patients (27), added modestly to these numbers and did not outperform matched control sites. All four sites showed an increase in percent of patients with OUD receiving M-OUD (mean increase = 9.88%; range: 7.01%-13.89%), outperforming many control sites (mean increase = 3.89%; range: -1.31%-17.57%).

Implications:
All intervention sites increased prescribers, patients and percent of patients receiving M-OUD over six months. Three of four outperformed their control sites. Intensive external facilitation appears to be an effective add-on strategy to improve performance in facilities that have not responded to ongoing operational-level efforts.

Impacts:
While the VHA has several initiatives in place to increase access to M-OUD, this is the first to specifically target low-adopting facilities and employ an intensive external facilitation process.