scholarly journals 3543 Translating the complex medical jargon of opioid use disorder and medication assisted treatment into locally relevant messages in rural Colorado using Boot Camp Translation

2019 ◽  
Vol 3 (s1) ◽  
pp. 97-98
Author(s):  
Mary Fisher ◽  
Donald E. Nease ◽  
Linda Zittleman ◽  
Jack Westfall ◽  
Jennifer Ancona
Keyword(s):  
Primary Care ◽  
Local Community ◽  
Boot Camp ◽  
Opioid Use Disorder ◽  
Research Network ◽  
High Plains ◽  
Opioid Use ◽  
Community Members ◽  
Medication Assisted Treatment ◽  
South Central

OBJECTIVES/SPECIFIC AIMS: Opioid use disorder (OUD) is a national epidemic and identified as a top priority by the practices and communities in rural Colorado. Until recently, few resources existed to address OUD in rural communities. In addition to training primary care and behavioral health practice teams in medication assisted treatment (MAT), Implementing Technology and Medication Assisted Treatment and Team Training and in Rural Colorado (IT MATTTRs Colorado) engaged local community members to alter the community conversation around OUD and treatment. For IT MATTTRs, the High Plains Research Network and the Colorado Research Network engaged community members in a 8-10 month process known as Boot Camp Translations (BCT) to translate medical information and jargon around OUD and MAT into concepts, messages, and materials that are meaningful and actionable to community members. The resulting community interventions are reported here. METHODS/STUDY POPULATION: IT MATTTRs conducted separate BCTs in Eastern Colorado and the south central San Luis Valley. Community partners included non-health professionals with diverse backgrounds, public health and primary care professionals, law enforcement, and others. The BCT process includes a comprehensive education on OUD and MAT and facilitated meetings and calls to develop messages and dissemination strategies. Each BCT lasted around 8-10 months. RESULTS/ANTICIPATED RESULTS: The BCT process elicited unique contextual ideas and constructs for messages, materials, and dissemination strategies. Themes common to both BCTs include the prevalence of OUD and that help is available in the local primary care office. Community-tailored messages are distributed through posters and flyer inserts, drink coasters, newspaper articles, letters to local judges, restaurant placemats, and websites. Examples of the materials and messages will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Local community members are eager to help address the OUD crisis. Built on community-based participatory research principles, BCT can be used to translate complex information and guidelines around OUD and MAT into messages and materials that reflect local culture and community needs.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

scholarly journals The Role of Primary Care in Improving Access to Medication-Assisted Treatment for Rural Medicaid Enrollees with Opioid Use Disorder

2019 ◽  
Vol 34 (6) ◽  
pp. 936-943 ◽  
Author(s):  
Evan S. Cole ◽  
Ellen DiDomenico ◽  
Gerald Cochran ◽  
Adam J. Gordon ◽  
Walid F. Gellad ◽  
...  
Keyword(s):  
Primary Care ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medication Assisted Treatment

scholarly journals Making the Random the Usual: Appreciative Inquiry/Boot Camp Translation—Developing Community-Oriented Evidence That Matters

2020 ◽  
Vol 11 ◽  
pp. 215013272090417
Author(s):  
Donald E Nease ◽  
Matthew J. Simpson ◽  
Linda Zittleman ◽  
Jodi Summers Holtrop ◽  
Tristen L. Hall ◽  
...  
Keyword(s):  
Mental Health ◽  
Appreciative Inquiry ◽  
Local Community ◽  
Boot Camp ◽  
Advisory Council ◽  
Research Network ◽  
High Plains ◽  
Community Partners ◽  
Usual Practice ◽  
Practice Based Research

Background: The evidence underlying clinical guidelines arising from typical scientific inquiry may not always match the needs and concerns of local communities. Our High Plains Research Network Community Advisory Council (HPRN CAC) identified a need for evidence regarding how to assist members of their community suffering from mental health issues to recognize their need for help and then obtain access to mental health care. The lack of evidence led our academic team to pursue linking Appreciative Inquiry with Boot Camp Translation (AI/BCT). This article describes the development and testing of this linked method. Method: We worked with the HPRN CAC and other communities affiliated with the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP) practice-based research networks to identify 5 topics for testing of AI/BCT. For each topic, we developed AI interview recruitment strategies and guides with our community partners, conducted interviews, and analyzed the interview data. Resulting themes for each topic were then utilized by 5 groups with the BCT method to develop community relevant messages and materials to communicate the evidence generated in each AI set of interviews. At each stage for each topic, notes on adaptations, barriers, and successes were recorded by the project team. Results: Each topic successfully led to generation of community specific evidence, messages, and materials for dissemination using the AI/BCT method. Beyond this, 5 important lessons emerged regarding the AI/BCT method: Researchers must (1) first ensure whether the topic is a good fit for AI, (2) maintain a focus on “what works” throughout all stages, (3) recruit one or more experienced qualitative analysts, (4) ensure adequate time and resources for the extensive AI/BCT process, and (5) present AI findings to BCT participants in the context of existing evidence and the local community and allow time for community partners to ask questions and request additional data analyses to be done. Conclusions: AI/BCT represents an effective way of responding to a community’s need for evidence around a specific topic where standard evidence and/or guidelines do not exist. AI/BCT is a method for turning the “random” successes of individuals into “usual” practice at a community level.

scholarly journals Building Capacity for Medication Assisted Treatment in Rural Primary Care Practices: The IT MATTTRs Practice Team Training

2020 ◽  
Vol 11 ◽  
pp. 215013272095372 ◽  
Author(s):  
Linda Zittleman ◽  
Kristen Curcija ◽  
Christin Sutter ◽  
L. Miriam Dickinson ◽  
John Thomas ◽  
...  
Keyword(s):  
Primary Care ◽  
Training Session ◽  
Team Training ◽  
Support Staff ◽  
Research Network ◽  
Care Practice ◽  
High Plains ◽  
Team Members ◽  
Medication Assisted Treatment ◽  
Practice Team

Objectives: In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT. Methods: PCPs in the High Plains Research Network and Colorado Research Network were randomized to receive team training either in-person or through virtual tele-mentoring. Training attendance logs recorded the number of participants and their roles. Participants completed a survey within one month of the last training session to evaluate satisfaction and ability to deliver components of MATs. Results: 441 team members at 42 PCPs were trained, including 22% clinicians, 47% clinical support staff, 24% administrative support staff. Survey respondents reported high levels of satisfaction, including 82% reporting improved understanding of the topic, and 68% identifying actions to apply information. Self-rated ability was significantly higher after training for all items ( P < .0001), including ability to identify patients for MAT and to manage patients receiving MAT. Mean change scores, adjusted for role, were significantly greater for all measures ( P < .001) in SOuND practices compared to ECHO practices. Conclusions: The IT MATTTRs Practice Team Training successfully engaged PCP team members in diverse roles in MAT for OUD training and increased self-efficacy to deliver MAT. Results support the training as a resource for a team-based approach to build rural practices’ capacity to deliver MAT.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

scholarly journals Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

2019 ◽  
Vol 32 (5) ◽  
pp. 724-731 ◽  
Author(s):  
Rebecca E. Cantone ◽  
Brian Garvey ◽  
Allison O'Neill ◽  
Joan Fleishman ◽  
Deborah Cohen ◽  
...  
Keyword(s):  
Primary Care ◽  
Treatment Initiation ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Care Model ◽  
Medication Assisted Treatment ◽  
Primary Care Model

Primary Care of Opioid use Disorder: The End of “the French Model”?

2020 ◽  
Vol 26 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Julie Dupouy ◽  
Sandy Maumus-Robert ◽  
Yohann Mansiaux ◽  
Antoine Pariente ◽  
Maryse Lapeyre-Mestre
Keyword(s):  
Primary Care ◽  
Private Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Number Of Patients ◽  
French Model

<b><i>Background:</i></b> In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. <b><i>Objectives:</i></b> Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. <b><i>Materials and Methods:</i></b> Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. <b><i>Results:</i></b> Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (<i>n</i> = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. <b><i>Conclusions:</i></b> Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

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