2019 HSR&D/QUERI National Conference
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)
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.
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.
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.
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.
Early results of this large implementation project suggest access to M-OUD care in VA can be improved.