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Croff R, Hoffman K, Alanis-Hirsch K, Ford J, McCarty D, Schmidt L. Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership. J Behav Health Serv Res 2020; 46:330-339. [PMID: 29845513 DOI: 10.1007/s11414-018-9616-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to adopting, implementing, and sustaining pharmacotherapy can be overcome through incremental testing of organizational change strategies, accompanied by expert coaching and a learning community of like-minded professionals. The greatest challenges lie in overcoming abstinence-only philosophies, establishing a business case for pharmacotherapy, and working with payers and pharmaceutical representatives.
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Affiliation(s)
- Raina Croff
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Kim Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA.
| | | | - Jay Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, 610 Walnut St, Madison, WI, 53726, USA
| | - Dennis McCarty
- Oregon Health and Science University-Portland State University School of Public Health, 3181 Sam Jackson Park Rd. CB669, Portland, OR, 97230, USA
| | - Laura Schmidt
- School of Medicine, University of California at San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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Abstract
Objective: Few studies examine how payers address the need for improved access to pharmacotherapy for opioid use disorders and the influence of environmental variables on access to opioid agonist and antagonist medications. Method: The 52 Ohio Addiction Drug Abuse and Mental Health Services (ADAMHS) Boards that disburse funds for treatment services for the uninsured and underinsured were surveyed to assess coverage for opioid agonist and antagonist treatment medications. Analyses examined public health data on regional opioid addiction patterns, characteristics of the local health insurance market, and their associations with coverage for opioid addiction pharmacotherapy. Results: Most (70%) of the 44 participating ADAMHS Boards paid for opioid treatment medications. For payment policy, all Boards required behavioral therapy to be provided in conjunction with opioid agonist or opioid antagonist therapy, and 27% of the Boards limited length of a buprenorphine therapy regimen. Higher local opioid treatment admission rates were associated with higher rates of Board funding for opioid treatment pharmacotherapy. Environmental variables (eg, overdose fatality rates or the behaviors of private insurance payers) were not associated with ADAMHS support for opioid agonist or antagonist medication. Conclusions: The analysis highlights the policy preferences of these payers. Follow-up studies should examine the payer decision-making processes, preferences, and attitudes that affect support for pharmacotherapy for opioid dependence.
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Molfenter T, McCarty D, Jacobson N, Kim JS, Starr S, Zehner M. The payer's role in addressing the opioid epidemic: It's more than money. J Subst Abuse Treat 2019; 101:72-78. [PMID: 31174716 DOI: 10.1016/j.jsat.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/12/2019] [Accepted: 04/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE County, State, and Federal agencies are addressing the public health opioid crisis. Ohio's 51 county-based Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Boards finance and regulate opioid treatment services within their jurisdictions. This three-year comparative trial collaborated with ADAMHS Boards (n = 14) to test the Advancing Recovery Framework, a suite of organizational and system change strategies designed to promote use of buprenorphine for opioid agonist therapy. METHODS A multi-level intervention directed payers and treatment agencies to leverage their roles in increasing the use of buprenorphine. Half of the boards partnered with local substance use disorder treatment providers using the partnership strategies recommended by the Advancing Recovery (AR) framework. The comparison boards did not use the partnership strategies. RESULTS AND CONCLUSION A logistic regression analysis detected increases in the number of patients receiving buprenorphine in both conditions. Buprenorphine use, as a percentage of patients with an opioid use disorder diagnosis, was significantly greater among the boards using the Advancing Recovery strategies during the three-year experimental period (odds ratio (OR) 1.63, 95% CI, 1.50 to 1.76, p < .001) and a one-year maintenance period (OR 2.13, 95% CI, 1.85 to 2.46, p < .001). Boards in both groups provided similar levels of financial support to implement and maintain buprenorphine prescribing. Strategy differences between the study conditions existed in use of a committee that facilitated payer-provider partnering and the ADAMHS boards setting expectations for using buprenorphine. Payer-provider partnerships achieved greater improvements and maximized the effectiveness of funding in increasing access to buprenorphine.
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Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, United States of America.
| | - Dennis McCarty
- Oregon Health & Science University, United States of America
| | - Nora Jacobson
- University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, United States of America
| | - Jee-Seon Kim
- University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, United States of America
| | - Sanford Starr
- Ohio Department of Mental Health and Addiction Services (OhioMHAS), United States of America
| | - Mark Zehner
- University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53706, United States of America
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Ford JH, Abraham AJ, Lupulescu-Mann N, Croff R, Hoffman KA, Alanis-Hirsch K, Chalk M, Schmidt L, McCarty D. Promoting Adoption of Medication for Opioid and Alcohol Use Disorders Through System Change. J Stud Alcohol Drugs 2018; 78:735-744. [PMID: 28930061 DOI: 10.15288/jsad.2017.78.735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The Medication Research Partnership (MRP), a collaboration between a national commercial health plan and nine addiction treatment centers, implemented organizational and system changes to promote use of federally approved medications for treatment of alcohol and opioid use disorders. METHOD A difference-in-differences analysis examined change over time in the percentage of patients receiving a prescription medication for alcohol or opioid use disorders treated in MRP (n = 9) and comparison (n = 15) sites. RESULTS MRP clinics experienced a 2.4-fold increase in patients receiving an alcohol or opioid prescription (13.2% at baseline to 31.7% at 3 years after MRP initiation); comparison clinics experienced significantly less change (17.6% to 23.5%) with an adjusted difference-in-differences of 12.5% (95% CI [5.4, 19.6], p = .001). MRP sites increased the patients with prescriptions to treat opioid use disorder from 17.0% (baseline) to 36.8% (3 years after initiation), with smaller changes observed in comparison sites (23.2% to 24.0%) and a 3-year post-initiation adjusted difference-in-differences of 19% (95% CI [8.5, 29.5], p = .000). Medications for alcohol use disorders increased in both MRP (9.0% to 26.5%) and comparison sites (11.4% to 23.1%). CONCLUSIONS Promoting the use of medications to support recovery required complex interventions. The Advancing Recovery System Change Model, initially developed in publicly funded systems of care, was successfully adapted for commercial sector use. The model provides a framework for providers and commercial health plans to collaborate and increase patient access to medications.
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Affiliation(s)
- James H Ford
- Center for Health Systems Research and Analysis, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amanda J Abraham
- Department of Public Administration and Policy, School of Public and International Affairs, University of Georgia, Athens, Georgia
| | - Nicoleta Lupulescu-Mann
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Raina Croff
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Kim A Hoffman
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | | | | | - Laura Schmidt
- School of Medicine, University of California at San Francisco, San Francisco, California
| | - Dennis McCarty
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
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Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain. J Subst Abuse Treat 2015; 60:110-8. [PMID: 26233697 DOI: 10.1016/j.jsat.2015.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022]
Abstract
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.
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Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, Starr S. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:13. [PMID: 25884206 PMCID: PMC4395880 DOI: 10.1186/s13011-015-0009-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/11/2015] [Indexed: 11/16/2022]
Abstract
Background Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption. Methods We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings. Results County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity. Conclusions This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization’s decision to begin buprenorphine use and that physician availability influences an organization’s ability to expand buprenorphine use over time. Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.
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Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Carol Sherbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Mark Zehner
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Andy Quanbeck
- University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin, 53706, USA.
| | - Dennis McCarty
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon, 97239-3098, USA.
| | - Jee-Seon Kim
- University of Wisconsin-Madison, School of Education, 1057 Educational Sciences, Madison, WI, 53706, USA.
| | - Sandy Starr
- Ohio Department of Mental Health and Addiction Services (OhioMHAS), 30 East Broad Street, 8th Floor, Columbus, Ohio, 43215, USA.
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