Abstract
BackgroundMillions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. We used an organizational readiness intervention comprised of a cluster of implementation strategies to prepare a federally qualified health center to deliver SUD screening and evidence-based treatments (extended-release injectable naltrexone (XR-NTX) for alcohol use disorders, buprenorphine/naloxone (BUP/NX) for opioid use disorders and a brief motivational interviewing/cognitive behavioral –based psychotherapy for both disorders). This article reports the effects of the intervention on key implementation outcomes.MethodsTo assess changes in organizational readiness we conducted pre- and post-intervention surveys with prescribing medical providers, behavioral health providers and general clinic staff (N = 69). We report on changes in implementation outcomes: acceptability, perceptions of appropriateness and feasibility, and intention to adopt the evidence-based treatments. We used Wilcoxon signed rank tests to analyze pre- to post-intervention changes.ResultsAfter 18 months, prescribing medical providers agreed more that XR-NTX was easier to use for patients with alcohol use disorders than before the intervention, but their opinions about the effectiveness and ease of use of BUP/NX for patients with opioid use disorders did not improve. Prescribing medical providers also felt more strongly after the intervention that XR-NTX for alcohol use disorders was compatible with current practices. Opinions of general clinic staff about the appropriateness of SUD treatment in primary care improved significantly.ConclusionsConsistent with implementation theory, we found that an organizational readiness implementation intervention enhanced perceptions in some domains of practice acceptability and appropriateness. Further research will assess whether these factors, which focus on individual staff readiness, change over time and ultimately predict adoption of SUD treatments in primary care.
Highlights
Millions of people with substance use disorders (SUDs) need, but do not receive, treatment
We hypothesized that a multi-component implementation intervention aimed at planning, educating providers and staff, and restructuring the care delivery system would lead to greater organizational readiness, measured by four implementation outcome domains: improved perceptions of acceptability, appropriateness, feasibility and intention or willingness to adopt evidence based treatments for Opioid and alcohol use disorders (OAUD); these hypotheses were partially supported
We found that an organizational readiness intervention consisting of multiple theoretically grounded implementation strategies aimed at the entire organization, improved some implementation outcomes related to integrating treatment for OAUDs in primary care, but not all
Summary
Millions of people with substance use disorders (SUDs) need, but do not receive, treatment. Delivering SUD treatment in primary care settings could increase access to treatment because most people visit their primary care doctors at least once a year, but evidence-based SUD treatments are underutilized in primary care settings. There is little available data on barriers to the uptake of SUD treatment by primary care providers, some of the known barriers include lack of leadership buy-in for integrating SUD care into medical practices; lack of confidence among physicians in their own or their clinic’s ability to treat SUDs; lack of adequate physician role models and access to decision support consultants; deficiencies in training and expertise in addiction treatment (i.e., workforce issues), Medicaid regulations that impede payment for the use of certain medications and same-day medical and mental health visits, and negative attitudes towards and biases against people with SUDs [21,22,23,24,25,26]. Providers in primary care clinics face large workloads, imbalance between skills and increasing job demands, and lack of team support, all of which can lead to burnout and could impede organizational readiness for and implementation of new practices [31,32,33]
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