Implementing Collaborative Care for Co-Occurring Disorders in low-resourced settings

Katherine Watkins, MD, MSHS
RAND Corporation

ABSTRACT:
Untreated co-occurring opioid use disorders and mental illness are prevalent and can have devastating consequences for the individual, their families, and the community. The Collaborative Care Model (CoCM) improves outcomes by addressing problems in access and quality for primary care patients with common behavioral health conditions but has not been implemented and tested for co-occurring disorders. This presentation will describe the development and implementation of a CoCM program for co-occurring opioid and mental health disorders in 17 primary care clinics in New Mexico and California. Using Proctor et al.’s 2011/2022 taxonomy of implementation outcomes and data from an ongoing clinical trial, we present the methods used to assess implementation outcomes and results of implementation efforts on model reach and fidelity. We compare the characteristics of individuals who received an initial session with a care coordinator with those whom the care coordinator was unable to engage. Understanding who does and does not receive CC may aid in developing implementation strategies to increase reach and fidelity

A tailored clinic-level intervention using a stepped-wedge design to increase PrEP uptake in primary care settings

Parya Saberi, PharmD, MAS, AAHIVP
University of California, San Francisco

Wayne Steward, PhD, MPH
University of California, San Francisco

ABSTRACT:
Lack of healthcare provider knowledge, capacity, and willingness to prescribe PrEP are barriers to PrEP delivery in clinical settings. In this presentation, we will discuss details of the PrEP Optimization Intervention (PrEP-OI) which combines a PrEP Coordinator with an online panel management tool to assist providers with PrEP uptake, persistence, and management in a large safety-net system. The intervention was rolled out at 12 primary care San Francisco Department of Public Health clinics using a stepped-wedge design preceding a follow-up phase. Additionally, we will review the challenges the study overcame with the development of PrEP-OI's technology-based component, onboarding and implementation, and response to the SARS-CoV-2 pandemic.

Using Systems Consultation to Improve Opioid Prescribing in Primary Care: Protocol for a Sequential, Multiple-Assignment Randomized Trial (SMART)

Andrew Quanbeck, PhD
Department of Family Medicine and Community Health
University of Wisconsin
School of Medicine and Public Health

ABSTRACT:
Background (context and purpose of the study) Health care systems are notoriously slow to adopt clinical guidelines and other evidence-based practices, in part because the literature offers little help about which implementation strategies work best in different clinical settings and how strategies could be tailored to maximize their effectiveness in different contexts. This study tests a blended implementation strategy called systems consultation to improve concordance with clinical guideline for opioid prescribing in primary care. Systems consultation consists of the following theoretically and empirically proven strategies: (1) an educational meeting followed by audit and feedback, (2) practice facilitation, and (3) physician peer consulting. The study aims to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics.

Methods (how the study will be performed) The study is a hybrid type 3 cluster-randomized sequential multiple-assignment randomized trial (SMART) that randomizes clinics at two timepoints, months 3 and 6 of an 18-month intervention period. The study will compare the effect on morphine-milligram equivalent dose of the elements of systems consultation. Four combinations of implementation strategies will be assessed: an educational meeting and audit and feedback alone (AF), AF plus practice facilitation (PF), AF + PF plus physician peer consulting (PPC), and AF + PPC. In addition, an assessment of system-, clinic-, and prescriber-level contextual factors will be developed and tested to build a tool for tailoring strategies to different clinics, and a cost estimate will be conducted of the strategies that make up systems consultation. The study aims to enroll up to 38 clinics from three health systems. Mixed methods will be used to evaluate systems consultation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Clinics will be the primary unit of analysis.

Discussion (summary and potential implications) Systems consultation is a practical blend of evidence-based strategies, in this case used to improve opioid prescribing practices in primary care. The blend offers a range of strategies from minimally to substantially intensive to make available the most cost-effective strategy(ies) for specific clinical contexts. Systems consultation and the adaptive approach used to deliver the strategy may generalize to the adoption of other evidence-based practices as well.

The SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) center to increase identification and treatment of opioid use disorder in VA primary care: An operationally-partnered internal facilitation implementation effort

Emily C. Williams, PhD, MPH
Department of Health Services
University of Washington

Eric J. Hawkins, PhD
Addiction Medicine
VA Puget Sound Health Care System

ABSTRACT:
Opioid use disorders (OUD) are increasingly common and dangerous. Though medication treatment of OUD is effective, recommended, and can be offered in primary care settings where patients with OUD are frequently seen, it is substantially underused with multiple barriers to its provision. The SUpporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center is a partnership between researchers and clinical leaders to assist VA primary care clinics in identifying and treating OUD. We will describe our operationally-partnered implementation efforts using internal facilitation and use of rapid mixed-methods formative evaluation to refine our implementation strategies, and we will present up-to-date evaluation results.

Approaches for implementing digital treatments for drug use disorders into primary care: A qualitative study of patient perspectives

Joseph E. Glass, PhD, MSW
Kaiser Permanente Washington Health Research Institute

ABSTRACT:
Researchers and health systems do not know how to care for large numbers of primary care patients with opioid and other substance use disorders, even though these conditions are increasingly deadly and costly. Digital treatments, or software-based care delivered via apps and websites, could be used to reach large numbers of patients with effective treatments. However, there is inadequate knowledge about how to support the delivery of digital treatments in primary care. This presentation will describe findings from research that engaged patient stakeholders to develop a user-centered approach for offering digital treatments to patients with opioid, stimulant, and cannabis use disorders.