Linda Zittleman1, Kristen Curcija2, Donald E Nease2, Mary Fisher2, L Miriam Dickinson2, John F Thomas3,4, Ashley Espinoza5, Christin Sutter2, Jennifer Ancona2, Jodi Summers Holtrop2, John M Westfall2,6. 1. University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado linda.zittleman@cuanschutz.edu. 2. University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado. 3. University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado. 4. University of Colorado School of Public Health, Department of Epidemiology, Aurora, Colorado. 5. High Plains Research Network, Community Advisory Council, University of Colorado School of Medicine, Department of Family Medicine, Denver, CO. 6. Robert Graham Center, Washington, DC.
Abstract
PURPOSE: Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado. METHODS: Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training. RESULTS: Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ 2 = 15.73, P <.001). CONCLUSIONS: The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.
PURPOSE: Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado. METHODS: Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training. RESULTS: Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ 2 = 15.73, P <.001). CONCLUSIONS: The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.
Authors: Mark Deyo-Svendsen; Matthew Cabrera Svendsen; James Walker; Andrea Hodges; Rachel Oldfather; Meghna P Mansukhani Journal: J Prim Care Community Health Date: 2020 Jan-Dec
Authors: Gerald Cochran; Evan S Cole; Jack Warwick; Julie M Donohue; Adam J Gordon; Walid F Gellad; Todd Bear; David Kelley; Ellen DiDomenico; Jan Pringle Journal: Addict Sci Clin Pract Date: 2019-08-01
Authors: Linda Zittleman; Kristen Curcija; Christin Sutter; L Miriam Dickinson; John Thomas; Dionisia de la Cerda; Donald E Nease; John M Westfall Journal: J Prim Care Community Health Date: 2020 Jan-Dec
Authors: Kristen Curcija; Linda Zittleman; Mary Fisher; Donald E Nease; L Miriam Dickinson; Dionisia de la Cerda; Christin Sutter; Jen Ancona; James Rank; John M Westfall Journal: J Rural Health Date: 2020-11-26 Impact factor: 5.667