Facility-level changes in receipt of pharmacotherapy for opioid use disorder: Implications for implementation science.
Background: The U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, faci...
| Published in: | Journal of Substance Abuse Treatment Vol. 95; pp. 43 - 48 |
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| Main Authors: | , , , , , , , |
| Format: | research Journal Article |
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Pergamon Press - An Imprint of Elsevier Science
Dec2018
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132512066&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 132512066 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07405472 JUB jtl: Journal of Substance Abuse Treatment issn: 07405472 maglogo: N pubinfo: dt: Dec2018 vid: 95 pid: 2410 pub: Pergamon Press - An Imprint of Elsevier Science artinfo: ui: 132512066 132512066 NLM30352669 132512066 10.1016/j.jsat.2018.09.006 NLM30352669 132512066 ppf: 43 ppct: 5 formats: tig: atl: Facility-level changes in receipt of pharmacotherapy for opioid use disorder: Implications for implementation science. aug: au: Finlay, Andrea K. Binswanger, Ingrid A. Timko, Christine Smelson, David Stimmel, Matthew A. Yu, Mengfei Bowe, Tom Harris, Alex H.S. affil: Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA sug: subj: Hospitals, Veterans Standards Clinical Indicators Substance Use Disorders Drug Therapy United States Department of Veterans Affairs Veterans United States Quality Improvement Buprenorphine Administration and Dosage Naltrexone Administration and Dosage Methadone Administration and Dosage Human Validation Studies Comparative Studies Evaluation Research Multicenter Studies Ferrans and Powers Quality of Life Index Impact of Events Scale ab: Background: The U.S. is facing an opioid epidemic, but despite mandates for pharmacotherapy for opioid use disorder to be available at Veterans Health Administration (VHA) facilities, the majority of veterans with opioid use disorder do not receive these medications. In implementation research, facilities are often targeted for qualitative inquiry or quality improvement efforts based on quality measure performance during a one-year period. However, sites that experience quality performance changes from one year to the next may be highly informative because mechanisms that impact facility change may be more discoverable. The current study examined changes in receipt of pharmacotherapy for opioid use disorder in a national healthcare system to determine the extent to which sites fluctuated in performance over a two-year period and illustrate how changes in quality measures over time may be useful for implementation research and healthcare surveillance of quality measures.Methods: Using national VHA data from Fiscal Years (FY) 2016 and 2017, we calculated quality measure performance as the number of patients who received pharmacotherapy for opioid use disorder (i.e., methadone, buprenorphine, and naltrexone) divided by the number of patients with a current non-remitted opioid use disorder diagnosis for each FY at each facility (n = 129) and examined change from FY16 to FY17.Results: The mean rate of receipt of pharmacotherapy for opioid use disorder was 38% (facility range = 3% to 74%) in FY16 and 41% (facility range = 2% to 76%) in FY17. The average facility-level change in performance was 3% and ranged from -19% to 26%. There were 32 facilities that decreased in provision of pharmacotherapy, 12 facilities with no change, and 85 facilities that increased.Conclusions: For facilities with average or high performance, it was difficult to maintain their performance over time. Identifying and learning from facilities with recent fluctuations may be more informative to guide the design of future quality improvement efforts than studying facilities with stable high or low performance. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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