Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

SUT 01-035 – HSR Study

 
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.


External Links for this Project

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project

PUBLICATIONS:

None at this time.


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

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.