2023 HSR&D/QUERI National Conference

4081 — Factors that Facilitate the Prescribing and Acceptance of Medications for Opioid Use Disorder in VA: Veteran and Provider Perspectives

Lead/Presenter: Alicia Bergman,  COIN - Los Angeles
All Authors: Bergman AA ((COIN Los Angeles)), Oberman, RS (Los Angeles COIN; Center for the Study of Healthcare Innovation, Implementation & Policy) Taylor SL (Los Angeles COIN; Center for the Study of Healthcare Innovation, Implementation & Policy) Chang E (Los Angeles COIN; Center for the Study of Healthcare Innovation, Implementation & Policy)

To address the overdoses and mortality associated with the opioid crisis, VISN 22 began a quality improvement project in 2018 to increase Veteran access to medications for opioid use disorder (MOUD) in non-addiction settings, such as primary care and mental health. MOUD, such as buprenorphine/naloxone, can effectively treat OUD and reduce opioid-related mortality. We sought to uncover the factors that can facilitate successful prescribing of MOUD and uptake/acceptance of MOUD by patients in non-addiction settings.

Qualitative interviews were conducted with 18 Veteran patients with experience taking MOUD (identified by addiction treatment providers at each facility) and 44 providers, most with MOUD experience or knowledge, including primary care providers, hospitalists, nurses, and addiction psychiatrists. The interviews were part of an evaluation of MOUD implementation in five medical centers in VISN22. The interview guide was developed based on the Practical, Robust Implementation and Sustainability Model (PRISM) and included questions about Veterans’/providers experiences with MOUD. Interviews were recorded, transcribed, and analyzed to identify major themes regarding Veterans'/providers perspectives and barriers and facilitators to implementing MOUD.

Provider-reported MOUD prescribing facilitators included protected clinical time (e.g., having a 2-hour block to perform inductions, building in time to see patients more frequently), changes in scopes of practice for some healthcare staff (role definition for nursing and justifying nurse workload), understanding the rewards/benefits of MOUD prescribing, interdisciplinary mentorship and support (e.g., consulting with addition providers, partnering with psychology), ongoing training and education to increase comfort in prescribing MOUD, incentives, leadership buy-in, administrative staff understanding scheduling issues, and contingency for other prescribers to cover MOUD prescribing when they are not available. Veteran-reported facilitators to MOUD access/use included specific communication strategies like providers emphasizing MOUD as an alternative to traditional opioids for pain, providers timing conversations about MOUD correctly (e.g., at low point or during/post crisis), the provider sharing the science of MOUD and how it works, and providers emphasizing the satisfaction/positive experiences of other patients taking MOUD.

Providers identified numerous multi-level factors (e.g., clinic-, provider- and system-level support), that can facilitate Veterans’ successful uptake of and MOUD prescribing in non-addiction settings. Factors that facilitated patient acceptance of MOUD centered mostly around communication strategies.

These findings can help VA providers across multiple settings and services develop communication strategies that can increase patient acceptance of MOUD. They also point to how interprofessional collaboration across VA services, and leadership support in making systems- and process-level adjustments, can facilitate MOUD prescribing for non-addiction providers.