Abstract
BackgroundGroup-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical “how to” components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment?MethodsTo create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish “core” and “malleable” components, and provide a conceptual framework for considering various options for implementing the malleable components.ResultsWe identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions.ConclusionWhile further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.
Highlights
Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting
We further revised the categories and their distinction as “core” vs. “malleable” through several processes: We held two focus groups with group-based opioid treatment (GBOT) site leaders, we reviewed initial interview notes, we referred back to the 10 additional GBOT publications identified through our systematic literature review [15], and we used our personal experience as GBOT program directors to arrive at 6 core and 14 malleable components that characterize GBOT implementation
Since our study is rooted in a case series approach, we considered organizational frameworks described in the case series literature which considers the contextual factors of structures, processes, and outcomes of systems-level changes [35,36,37,38,39]
Summary
Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. Opioid use disorder (OUD) has reached epidemic proportions in the U.S Every day, more than 115 people die after overdosing on opioids [1], and opioid overdoses recently surpassed motor vehicle accidents as the most common cause of accidental death [2, 3]. Medications for Opioid Use Disorder (MOUD), methadone, buprenorphine– naloxone (B/N), and naltrexone, are highly effective [4]. While many outpatient providers currently offer B/N to patients via one-to-one provider visits, group-based opioid treatment (GBOT) [9] has recently emerged as a treatment option. Because patients living with chronic disease often feel a sense of shame and isolation, bringing individuals together in a protected and safe space can potentially create a healing community where members develop connections to others with similar conditions, learn from each other, and gain a sense of validation and hope [13]
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