E Jennifer Edelman1,2,3, Geliang Gan4, James Dziura4,5, Denise Esserman4,6, Kenneth L Morford1,2, Elizabeth Porter2, Philip A Chan7, Deborah H Cornman8, Benjamin J Oldfield1,2, Jessica E Yager9, Srinivas B Muvvala1,10, David A Fiellin1,2,3,5. 1. Program in Addiction Medicine, Yale School of Medicine, New Haven, CT. 2. Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 3. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT. 4. Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT. 5. Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT; and. 6. Biostatistics, Yale School of Public Health, New Haven, CT. 7. Department of Medicine, Brown University, Providence, RI. 8. Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT. 9. Department of Medicine, SUNY Downstate, Brooklyn, NY; and. 10. Department of Psychiatry, Yale School of Medicine, New Haven, CT.
Abstract
BACKGROUND: We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. SETTING: Four HIV clinics in the northeastern United States. METHODS: Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups. RESULTS: Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork. CONCLUSIONS: Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.
BACKGROUND: We sought to characterize readiness, barriers to, and facilitators of providing medications for addiction treatment (MAT) in HIV clinics. SETTING: Four HIV clinics in the northeastern United States. METHODS: Mixed-methods formative evaluation conducted June 2017-February 2019. Surveys assessed readiness [visual analog scale, less ready (0-<7) vs. more ready (≥7-10)]; evidence and context ratings for MAT provision; and preferred addiction treatment model. A subset (n = 37) participated in focus groups. RESULTS: Among 71 survey respondents (48% prescribers), the proportion more ready to provide addiction treatment medications varied across substances [tobacco (76%), opioid (61%), and alcohol (49%) treatment medications (P values < 0.05)]. Evidence subscale scores were higher for those more ready to provide tobacco [median (interquartile range) = 4.0 (4.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.008] treatment medications, but not significantly different for opioid [5.0 (4.0, 5.0) vs. 4.0 (4.0, 5.0), P = 0.11] and alcohol [4.0 (3.0, 5.0) vs. 4.0 (3.0, 4.0), P = 0.42] treatment medications. Median context subscale scores ranged from 3.3 to 4.0 and generally did not vary by readiness status (P values > 0.05). Most favored integrating MAT into HIV care but preferred models differed across substances. Barriers to MAT included identification of treatment-eligible patients, variable experiences with MAT and perceived medication complexity, perceived need for robust behavioral services, and inconsistent availability of on-site specialists. Facilitators included knowledge of adverse health consequences of opioid and tobacco use, local champions, focus on quality improvement, and multidisciplinary teamwork. CONCLUSIONS: Efforts to implement MAT in HIV clinics should address both gaps in perspectives regarding the evidence for MAT and contextual factors and may require substance-specific models.
Authors: Brian T Montague; Christopher W Kahler; Suzanne M Colby; R Kathryn McHugh; Daniel Squires; Brianne Fitzgerald; Don Operario; Donna Gallagher; Peter M Monti; Kenneth H Mayer Journal: Addict Disord Their Treat Date: 2015-03
Authors: Amy C Justice; Kathleen A McGinnis; Janet P Tate; R Scott Braithwaite; Kendall J Bryant; Robert L Cook; E Jennifer Edelman; Lynn E Fiellin; Matthew S Freiberg; Adam J Gordon; Kevin L Kraemer; Brandon D L Marshall; Emily C Williams; David A Fiellin Journal: Drug Alcohol Depend Date: 2016-01-29 Impact factor: 4.492
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Authors: E Jennifer Edelman; James Dziura; Denise Esserman; Elizabeth Porter; William C Becker; Philip A Chan; Deborah H Cornman; Gabriel Rebick; Jessica Yager; Kenneth Morford; Srinivas B Muvvala; David A Fiellin Journal: Contemp Clin Trials Date: 2020-09-23 Impact factor: 2.226
Authors: Krysten W Bold; Yanhong Deng; James Dziura; Elizabeth Porter; Keith M Sigel; Jessica E Yager; David M Ledgerwood; Steven L Bernstein; E Jennifer Edelman Journal: Transl Behav Med Date: 2022-07-07 Impact factor: 3.626
Authors: Kenneth L Morford; Srinivas B Muvvala; Philip A Chan; Deborah H Cornman; Molly Doernberg; Elizabeth Porter; Michael Virata; Jessica E Yager; David A Fiellin; E Jennifer Edelman Journal: J Subst Abuse Treat Date: 2022-03-18
Authors: Benjamin J Oldfield; Yu Li; Rachel Vickers-Smith; Declan T Barry; Stephen Crystal; Kirsha S Gordon; Robert D Kerns; Emily C Williams; Brandon D L Marshall; E Jennifer Edelman Journal: Alcohol Clin Exp Res Date: 2022-03-16 Impact factor: 3.928
Authors: E Jennifer Edelman; James Dziura; Yanhong Deng; Krysten W Bold; Sean M Murphy; Elizabeth Porter; Keith M Sigel; Jessica E Yager; David M Ledgerwood; Steven L Bernstein Journal: Contemp Clin Trials Date: 2021-03-29 Impact factor: 2.226
Authors: Sharanya Rao; Ashley E Reed; Benjamin Parchem; E Jennifer Edelman; Manya Magnus; Nathan B Hansen; Trace S Kershaw; Valerie A Earnshaw; Douglas S Krakower; John F Dovidio; Kenneth H Mayer; Kristen Underhill; Joshua G Rosenberger; Damon F Ogburn; Joseph R Betancourt; Sarah K Calabrese Journal: AIDS Behav Date: 2021-07-21