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A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings

Spelman JF, Edens EL, Maya S, Moore BA, MacLean RR, Ackland PE, Becker WC, Lynch D, Garcia-Vassallo M, Burgo AL, Rosen MI, Gordon AJ. A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental Health Settings. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2021 Oct 14; 38(10):460-464.

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Abstract:

Background: The opioid epidemic in the United States has generated a pressing need to enhance access to medica%2tions for opioid use disorder (MOUD). This program descrip%2tion illustrates a quality-improvement effort to extend MOUD to primary care and general mental health clinics within the US Department of Veterans Affairs (VA) Connecticut Health,are system (VACHS), and to examine barriers and facilitators to implementation of MOUD in target clinics. Observations: As part of the national VA Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative to improve MOUD access, a VACHS team identified and resolved barriers to MOUD in target clinics. Key interven%2tions were to obtain leadership support, increase waivered prescribers, and develop processes and tools to enhance prescribing. New initiatives included quarterly educational sessions, templated progress notes, and instant messag%2ing for addiction specialist electronic consultations. MOUD receipt and prescriber characteristics were evaluated be/ore and 1 year after implementation. There was a 4% in,rease in eligible patients receiving MOUD, from 552 (44%) to 582 (48%) (P = .04). The number of waivered prescribers increased from 67 to 131, and the number of buprenorphine prescribers increased from 35 to 52 over a 6-month span, and the percentage of health care practitioners capable of pre%2scribing within the electronic health record increased from 75% to 89% (P = .01). Conclusions: An interdisciplinary team approach to identify%2ing and overcoming barriers to MOUD target clinics expands access. Key interventions include interdisciplinary leadership engagement, proactive education and incentivization of target prescribers, removal of procedural barriers, and development of tools to facilitate and support prescribing. These concrete interventions can help inform other institutions interested in expanding MOUD access.





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