An intervention program for nonaddiction clinics within the United States Veterans Health Administration health care system helped improve prescription rates for medications used to treat opioid use disorder (OUD). A study published in JAMA Network tested an intervention program that included education, implementation teams, external facilitators, and monthly reports.
The researchers argued that medication-assisted treatment for OUD is underused, despite improvement in access. About 35% of patients within the Veterans Affairs (VA) health system with OUD receive medication-assisted treatment. To improve access to medication-assisted treatment, the VA launched the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) initiative in 2018. The JAMA study evaluated the effectiveness of the SCOUTT program.
The researchers evaluated 35 clinics from within 18 VA facilities, 1 from each of the VA’s 18 networks. The researchers compared those clinics to clinics with similar characteristics. The evaluation period ran from 2017 through 2019, covering a 1-year period before and after SCOUTT launched. The primary outcome was the monthly proportion of patients who were prescribed buprenorphine or injectable naltrexone in intervention and comparison clinics during the 12-month period before and after the SCOUTT launch.
A total of 7,488 patients were seen in intervention clinics, most of them (91.6%) male and white (68.9%). A total of 2,432 (32.5%) received medication assistance for OUD before SCOUTT. Use of medication intervention rose 3.3% (absolute increase) during SCOUTT. Use of medication did not increase in comparison clinics. The annual percentage of medication intervention increased from 6.3% to 13.6% from 2017 to 2019 in the intervention clinics and from 4.2% to 6.1% in comparison clinics.
Residual confounding or other ongoing VA programs may have influenced results. Prescribing trends are limited to the initial launch of SCOUTT and may not reflect changes over longer periods of time. Also, results from within the VA system may not reflect OUD medication treatment outside VA clinics.
The results suggest “a multifaceted implementation approach used to engage clinicians in primary care, mental health, and pain clinics in MOUD [medications for Opioid Use Disorder] delivery is associated with an increase in prescriber productivity and patient access to MOUD,” the researchers conclude.
“Implementing SCOUTT-like initiatives in clinics with infrastructure to support MOUD prescribing may assist health care systems in reaching patients who do not access traditional OUD treatment.”
Hawkins EJ, Malte CA, Gordon AJ, et al. Accessibility to medication for opioid use disorder after interventions to improve prescribing among nonaddiction clinics in the US veterans health care system. JAMA Netw Open. Published online December 21, 2021 doi:10.1001/jamanetworkopen.2021.37238