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SUT 01-035 – HSR&D Study

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SUT 01-035
Improving Access to Effective Opioid Agonist Therapy
Mark L. Willenbring MD
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, MN
Funding Period: April 2001 - September 2003

BACKGROUND/RATIONALE:
Opioid agonist therapy (OAT), commonly known as methadone maintenance, has considerable evidence supporting its effectiveness and its cost effectiveness. In addition, evidence has been accumulating concerning the contribution to outcome of specific programmatic elements. This evidence base coupled with the relatively small numer and contained nature of OAT treatment programs makes OAT an ideal candidate for translation.

OBJECTIVE(S):
The primary objectives are to 1) Increase access to OAT. Specifically, we aim to increase the number of OAT treatment slots available (daily capacity) by 10% by 12/01 and an additional 10% (total increase 20%) by 9/03. 2) Improve outcomes (street drug use and program retention) through improvement in the quality of OAT services. A secondary aim is to develop a toolkit for quality improvement in OAT and make this toolkit available for dissemination to programs not participating in this project, as well as to programs outside of VA. Additionally, we will share our results with the Center for Substance Abuse Treatment, which is developing an accreditation process for OAT programs nationwide. We expect to increase access to OAT services through addition of new methadone programs, and expansion of existing programs, with funds provided by recent legislation. Access will be further increased through implementaiton of office-based treatment with buprenorphine, a partial opioid agonist.

METHODS:
We will use a facilitated quality improvement (FQI) process to improve outcomes in existing programs. It will focus on program elements with solid evidence of efficacy: 1) dosing strategy, 2) counseling frequency, 3) maintenance (vs. detoxification) orientation of program, and 4) contingency management. We will recruit 8 treatment programs, four of which will be randomly selected for the FQI intervention, while the other 4 serve as controls during the first QI cycle. The FQI process will include local teams, but project staff will provide technical assistance and staff to assist programs to carry out many of the tasks. An extensive qualitative analysis will examine the FQI process and determine the extent to which desired change occurs. Outcome measures will be measures of access, street drug use and program retention. Experimental and control programs will be compared on these outcome measures. After the first QI cycle is complete, the control programs will participate in the facilitated FQI process as well, while the first group develops a second FQI cycle. In the second project year, we will refine and simplify the process for wider dissemination.

FINDINGS/RESULTS:
There are no findings to date.

IMPACT:
Improving access to and quality of opioid agonist therapy is likely to substantially reduce excess morbidity and mortality among opioid addicts.

PUBLICATIONS:

Journal Articles

  1. Harris AH, Bowe T, Finney JW, Humphreys K. HEDIS initiation and engagement quality measures of substance use disorder care: impact of setting and health care specialty. Population health management. 2009 Aug 1; 12(4):191-6.
  2. Weitlauf JC, Finney JW, Ruzek JI, Lee TT, Thrailkill A, Jones S, Frayne SM. Distress and pain during pelvic examinations: effect of sexual violence. Obstetrics and gynecology. 2008 Dec 1; 112(6):1343-50.
  3. Hagedorn H, Hogan M, Smith JL, Bowman C, Curran GM, Espadas D, Kimmel B, Kochevar L, Legro MW, Sales AE. Lessons learned about implementing research evidence into clinical practice. Experiences from VA QUERI. Journal of general internal medicine. 2006 Feb 1; 21 Suppl 2:S21-4.
  4. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, Kimmel B, Sharp ND, Smith JL. The role of formative evaluation in implementation research and the QUERI experience. Journal of general internal medicine. 2006 Feb 1; 21 Suppl 2:S1-8.
  5. Willenbring ML, Hagedorn HJ, Postier AC, Kenny M. Variations in evidence-based clinical practices in nine United States Veterans Administration opioid agonist therapy clinics. Drug and Alcohol Dependence. 2004 Jul 15; 75(1):97-106.
  6. Willenbring ML, Kivlahan D, Kenny M, Grillo M, Hagedorn H, Postier A. Beliefs about evidence-based practices in addiction treatment: a survey of Veterans Administration program leaders. Journal of substance abuse treatment. 2004 Mar 1; 26(2):79-85.
Book Chapters

  1. Willenbring ML, Hagedorn H. Implementing evidence-based practices in opioid agonist clinics. In: Roberts AR, Yeager KR, editors. Evidence-Based Practice Manual: Research and Outcome Measures in Health and Human Services. New York, NY: Oxford University Press; 2004. Chapter 35. 340-347 p.
Conference Presentations

  1. Harris AH, Humphreys KN, Bowe T, Kivlahan D, Hyun J, Finney JW. Developing a New Quality Measure of Outpatient Addiction Treatment for the VA. Paper presented at: Addiction Health Services Research Conference; 2008 Oct 21; Boston, MA.


DRA: Substance Abuse and Addiction, Health Systems
DRE: Treatment - Observational, Prevention
Keywords: Drug abuse, Service lines, Translation
MeSH Terms: Drug Therapy

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