scholarly journals Translating Medicaid policy into practice: policy implementation strategies from three US states’ experiences enhancing substance use disorder treatment

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Erika L. Crable ◽  
Allyn Benintendi ◽  
David K. Jones ◽  
Alexander Y. Walley ◽  
Jacqueline Milton Hicks ◽  
...  
Keyword(s):  
Substance Use ◽  
Policy Implementation ◽  
Substance Use Disorder ◽  
Service Providers ◽  
Implementation Strategies ◽  
Local Context ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Addiction Medicine ◽  
Us States

Abstract Background Despite the important upstream impact policy has on population health outcomes, few studies in implementation science in health have examined implementation processes and strategies used to translate state and federal policies into accessible services in the community. This study examines the policy implementation strategies and experiences of Medicaid programs in three US states that responded to a federal prompt to improve access to evidence-based practice (EBP) substance use disorder (SUD) treatment. Methods Three US state Medicaid programs implementing American Society of Addiction Medicine (ASAM) Criteria-driven SUD services under Section 1115 waiver authority were used as cases. We conducted 44 semi-structured interviews with Medicaid staff, providers and health systems partners in California, Virginia, and West Virginia. Interviews were triangulated with document review of state readiness and implementation plans. The Exploration, Preparation, Implementation, Sustainment Framework (EPIS) guided qualitative theme analysis. The Expert Recommendations for Implementing Change and Specify It criteria were used to create a taxonomy of policy implementation strategies used by policymakers to promote providers’ uptake of statewide EBP SUD care continuums. Results Four themes describe states’ experiences and outcomes implementing a complex EBP SUD treatment policy directive: (1) Medicaid agencies adapted their inner/outer contexts to align with EBPs and adapted EBPs to fit their local context; (2) enhanced financial reimbursement arrangements were inadequate bridging factors to achieve statewide adoption of new SUD services; (3) despite trainings, service providers and managed care organizations demonstrated poor fidelity to the ASAM Criteria; and (4) successful policy adoption at the state level did not guarantee service providers’ uptake of EBPs. States used 29 implementation strategies to implement EBP SUD care continuums. Implementation strategies were used in the Exploration (n=6), Preparation (n=10), Implementation (n=19), and Sustainment (n=6) phases, and primarily focused on developing stakeholder interrelationships, evaluative and iterative approaches, and financing. Conclusions This study enhances our understanding of statewide policy implementation outcomes in low-resource, public healthcare settings. Themes highlight the need for additional pre-implementation and sustainment focused implementation strategies. The taxonomy of detailed policy implementation strategies employed by policymakers across states should be tested in future policy implementation research.

scholarly journals How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study

2019 ◽  
Vol 13 ◽  
pp. 117822181983337 ◽  
Author(s):  
Henning Pettersen ◽  
Anne Landheim ◽  
Ivar Skeie ◽  
Stian Biong ◽  
Morten Brodahl ◽  
...  
Keyword(s):  
Substance Use ◽  
Social Relationships ◽  
Substance Use Disorder ◽  
Service Providers ◽  
Treatment Strategies ◽  
Support Network ◽  
Structured Interviews ◽  
Narrative Study ◽  
Study Planning ◽  
Caring Relationship

Individuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.

scholarly journals Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: a Propensity-Matched Analysis

2019 ◽  
Vol 34 (12) ◽  
pp. 2796-2803 ◽  
Author(s):  
Honora Englander ◽  
Konrad Dobbertin ◽  
Bonnie K. Lind ◽  
Christina Nicolaidis ◽  
Peter Graven ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Treatment Engagement ◽  
Addiction Medicine ◽  
Substance Use Disorder Treatment ◽  
Disorder Treatment

scholarly journals 780. Inpatient Addiction Medicine Consultations at the Urban/Rural Frontier: Improving Quality of Care and Linkage to Outpatient Services for Patients with Substance Use Disorder in Central Kentucky

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S346-S346
Author(s):  
Laura Fanucchi ◽  
Devin Oller
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Medical Advice ◽  
Outpatient Services ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Opioid Treatment ◽  
Rural Counties ◽  
Discharge Against Medical Advice ◽  
The University

Abstract Background When persons with opioid use disorder (OUD) are hospitalized with medical complications (e,g. endocarditis, viral hepatitis) they frequently do not receive medications for the underlying OUD. In recent years, a number of hospitals have implemented addiction medicine consultation (AMC) services to help address this treatment gap, though these are all in large urban centers. AMCs provide comprehensive substance use disorder (SUD) assessments, manage SUDs, initiate pharmacotherapy for OUD, and arrange linkage to ongoing treatment. The aim of this study was to describe the initial implementation and outcomes of a new AMC at the University of Kentucky Hospital, a 945-bed tertiary referral center with a large rural catchment. Methods The Addiction Consultation and Education Service(ACES) began October, 2018 and was comprised of several physicians and an APRN. A patient navigator assisted with prior authorizations and outpatient linkage. ACES referred to a new bridge clinic at the University for ongoing office-based opioid treatment as well as to community programs and licensed opioid treatment programs. Patient demographics, SUD diagnoses, and comorbidities (including details of the injection-related infections) are collected from the electronic health record, as well as key process metrics including: time-to-consultation and medication initiation, length of stay(LOS), discharge against medical advice(AMA), and details of linkage to outpatient services. Results From October-December, 91 patients were seen, 73 met DSM-5 criteria for OUD, 82 had a medical complication of SUD, and 53 lived in rural counties (Rural-Urban Continuum Codes 4–9). Average LOS was 19.5 days. Among OUD patients, 71% underwent buprenorphine/naloxone induction, 9% were started on methadone. Less than 6% of patients started on buprenorphine or methadone left against medical advice. Conclusion AMCs are a key part of providing comprehensive care for persons hospitalized with infectious complications of substance use. Initiating medication for OUD likely decreases rates of discharge against medical advice. Compared with other AMCs, a greater percentage of patients seen by ACES resided in rural counties. Establishing a bridge clinic prior to starting an AMC is critical to ensure ongoing care. Disclosures All authors: No reported disclosures.

scholarly journals Reorganization of Substance Use Treatment and Harm Reduction Services During the COVID-19 Pandemic: A Global Survey

2021 ◽  
Vol 12 ◽  
Author(s):  
Seyed Ramin Radfar ◽  
Cornelis A. J. De Jong ◽  
Ali Farhoudian ◽  
Mohsen Ebrahimi ◽  
Parnian Rafei ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Service Providers ◽  
Vulnerable Groups ◽  
Business Continuity ◽  
Treatment Modalities ◽  
Addiction Medicine ◽  
Global Survey ◽  
Prevention Interventions ◽  
Needle And Syringe Programs

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic.Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health responses in their own 77 countries in terms of SUD treatment and harm reduction services. The health responses were categorized around (1) managerial measures and systems, (2) logistics, (3) service providers, and (4) vulnerable groups.Results: Respondents from over 88% of countries reported that core medical and psychiatric care for SUDs had continued; however, only 56% of countries reported having had any business continuity plan, and 37.5% of countries reported shortages of methadone or buprenorphine supplies. Participants of 41% of countries reported partial discontinuation of harm-reduction services such as needle and syringe programs and condom distribution. Fifty-seven percent of overdose prevention interventions and 81% of outreach services were also negatively impacted.Conclusions: Participants reported that SUD treatment and harm-reduction services had been significantly impacted globally early during the COVID-19 pandemic. Based on our findings, we highlight several issues and complications resulting from the pandemic concerning people with SUDs that should be tackled more efficiently during the future waves or similar pandemics. The issues and potential strategies comprise the following: (1) helping policymakers to generate business continuity plans, (2) maintaining the use of evidence-based interventions for people with SUDs, (3) being prepared for adequate medication supplies, (4) integrating harm reduction programs with other treatment modalities, and (5) having specific considerations for vulnerable groups such as immigrants and refugees.

scholarly journals Buprenorphine: Not a silver bullet, and still controversial

2021 ◽  
Vol 17 (7) ◽  
pp. 9-10
Author(s):  
Sudheer Potru, DO, FASAM ◽  
Michael Sprintz, DO, DFASAM ◽  
Antje M. Barreveld, MD ◽  
Lynn Kohan, MD
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Working Group ◽  
Ad Hoc ◽  
Hospital Setting ◽  
Outpatient Setting ◽  
Pain Medicine ◽  
Appropriate Use ◽  
Addiction Medicine ◽  
Silver Bullet

We are practitioners of pain medicine and addiction medicine and also four of the seven members of the Multi-Society Ad Hoc Substance Use Disorder (SUD) Working Group comprised of representatives from anesthesia, pain, pharmacy, and addiction medicine societies. We are finalizing “tip sheets” and a consensus-based manuscript to provide guidance on the appropriate use and initiation of buprenorphine in the hospital setting by anesthesiologists, and in the outpatient setting by pain clinicians.

scholarly journals The impact of COVID-19 on substance use disorder treatment in California: Service providers' perspectives

2021 ◽  
pp. 108544
Author(s):  
Chunqing Lin ◽  
Sarah E. Clingan ◽  
Sarah J. Cousins ◽  
Jonathan Valdez ◽  
Larissa J. Mooney ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Service Providers ◽  
Substance Use Disorder Treatment ◽  
Disorder Treatment ◽  
The Impact

scholarly journals A Pilot Study Comparing Tools for Tracking Implementation Strategies and Treatment Adaptations

2020 ◽  
Author(s):  
Callie Walsh-Bailey ◽  
Lorella G. Palazzo ◽  
Salene M. W. Jones ◽  
Kayne D. Mettert ◽  
Byron J. Powell ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Local Context ◽  
Mental Health Providers ◽  
Health Providers ◽  
Structured Interviews ◽  
Evidence Based Practices ◽  
Web Based ◽  
Stakeholder Groups ◽  
Tracking Process ◽  
Pragmatic Measures

Abstract Background Tailoring implementation strategies and adapting treatments to better fit the local context may improve their effectiveness. However, there is a dearth of valid, reliable, pragmatic measures that allow for the prospective tracking of strategies and adaptations according to reporting recommendations. This study describes the development and pilot testing of three tools to designed to serve this purpose. Methods Measure development was informed by two systematic reviews of the literature (implementation strategies, treatment adaptation). The three resulting tools vary with respect to the degree of structure (Brainstorming Log = low, Activity Log = moderate, Detailed Tracking Log = high). To prospectively track treatment adaptations and implementation strategies, three stakeholder groups (treatment developer, implementation practitioners, mental health providers) were randomly assigned one tool per week via an anonymous web-based survey for nine weeks and incentivized to participate. Three established implementation outcome measures, the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were used to assess the tools. Semi-structured interviews were conducted to gather more nuanced information from stakeholders regarding their perceptions of the tools and the tracking process. Results The three tracking tools demonstrated moderate to good acceptability, appropriateness, and feasibility; the Activity Log was deemed the most feasible of the three tools. Implementation practitioners rated the tools the highest of the three stakeholder groups. The tools took an average of 15 minutes or less to complete. Conclusion This study sought to fill methodological gaps that prevent stakeholders and researchers from discerning which strategies are most important to deploy for promoting implementation and sustainment of evidence-based practices. These tools would allow researchers and practitioners to track whether activities were treatment adaptations or implementation strategies and what barrier(s) each target. These tools could inform prospective tailoring of implementation strategies and treatment adaptations, which would promote scale out and spread.

scholarly journals Making Gendered Healthcare Work Visible: Over-Looked Labour in Four Diverse European Settings

2019 ◽  
Vol 7 (2) ◽  
pp. 33-43 ◽  
Author(s):  
Hannah Bradby ◽  
Jenny Phillimore ◽  
Beatriz Padilla ◽  
Tilman Brand
Keyword(s):  
Service Providers ◽  
Point Of View ◽  
Health Needs ◽  
Health Priorities ◽  
Public Healthcare ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
The Public ◽  
Universal Healthcare ◽  
Healthcare Work

Healthcare has long been a gendered enterprise, with women taking responsibility for maintaining health and engaging with service providers. Universal healthcare provision notwithstanding, women nonetheless undertake a range of healthcare work, on their own account and on behalf of others, which remains largely invisible. As part of a multi-method comparative European study that looked at access to healthcare in diverse neighbourhoods from the point of view of people’s own health priorities, the concept of ‘healthcare bricolage’ describes the process of mobilizing resources and overcoming constraints to meet particular health needs. Bricolage mediates between different kinds of resources to meet particular challenges and describing these processes makes visible that work which has been unseen, over-looked and naturalised, as part of a gendered caring role. Drawing on 160 semi-structured interviews and a survey with 1,755 residents of highly diverse neighbourhoods in Germany, UK, Sweden and Portugal, this article illustrates the gendered nature of healthcare bricolage. The complex variations of women’s bricolage within and beyond the public healthcare system show how gendered caring roles intersect with migration status and social class in the context of particular healthcare systems.

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