scholarly journals Multifaceted Quality Improvement Initiative Improves Retention in Treatment for Youth with Opioid Use Disorder

2019 ◽  
Vol 4 (3) ◽  
pp. e174
Author(s):  
Casey B. Cottrill ◽  
Stephanie Lemle ◽  
Steven C. Matson ◽  
Andrea E. Bonny ◽  
Erin R. McKnight
Keyword(s):  
Quality Improvement ◽  
Opioid Use Disorder ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Retention In Treatment

scholarly journals Prior National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder trials as background and rationale for NIDA CTN-0100 “optimizing retention, duration and discontinuation strategies for opioid use disorder pharmacotherapy (RDD)”

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Matisyahu Shulman ◽  
Roger Weiss ◽  
John Rotrosen ◽  
Patricia Novo ◽  
Elizabeth Costello ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Extended Release ◽  
Primary Outcome ◽  
Opioid Use Disorder ◽  
Drug Abuse Treatment ◽  
Opioid Use ◽  
National Drug ◽  
Retention In Treatment ◽  
Abuse Treatment

AbstractOpioid use disorder continues to be a significant problem in the United States and worldwide. Three medications—methadone, buprenorphine, and extended-release injectable naltrexone,— are efficacious for treating opioid use disorder (OUD). However, the utility of these medications is limited, in part due to poor rates of retention in treatment. In addition, minimum recovery milestones and other factors that influence when and whether individuals can safely discontinue medications are unknown. The National Drug Abuse Treatment Clinical Trials Network (CTN) study “Optimizing Retention, Duration, and Discontinuation Strategies for Opioid Use Disorder Pharmacotherapy” (RDD; CTN-0100) will be among the largest clinical trials on treatment of OUD yet conducted, consisting of two phases, the Retention phase, and the Duration-Discontinuation phase. The Retention phase, open to patients initiating treatment, will test different doses and formulations of buprenorphine (standard dose sublingual, high dose sublingual, or extended-release injection), and a digital therapeutic app delivering contingency management and cognitive behavioral counseling on the primary outcome of retention in treatment. The Discontinuation phase, open to patients in stable remission from OUD and choosing to discontinue medication (including participants from the Retention phase or from the population of patients treated at the clinical site, referred by an outside prescriber or self-referred) will study different tapering strategies for buprenorphine (sublingual taper vs taper with injection buprenorphine), and a digital therapeutic app which provides resources to promote recovery, on the primary outcome of relapse-free discontinuation of medication. This paper describes how the RDD trial derives from two decades of research in the CTN. Initial trials (CTN-0001; CTN-0002; CTN-0003) focused on opioid detoxification, showing buprenorphine-naloxone was effective for detoxification, but that acute detoxification did not appear to be an effective treatment strategy. Trials on comparative effectiveness of medications for opioid use disorder (MOUD) (CTN-0027; CTN-0030; and CTN-0051) highlighted the problem of dropout from treatment and few trials defined retention on MOUD as the primary outcome. Long-term follow-up studies on those patient samples demonstrated the importance of long-term continuation of medication for many patients to sustain remission. Overall, these trials highlight the potential of a stable research infrastructure such as CTN to advance treatment effectiveness through a programmatic succession of large clinical trials.

Variation in emergency department visit rates for opioid use disorder: Implications for quality improvement initiatives

2021 ◽  
Author(s):  
Utsha G. Khatri ◽  
Elizabeth A. Samuels ◽  
Ruiying Xiong ◽  
Brandon D.L. Marshall ◽  
Jeanmarie Perrone ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Emergency Department Visit ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rachel Lamont ◽  
Tea Rosic ◽  
Nitika Sanger ◽  
Zainab Samaan
Keyword(s):  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Mood Stabilizers ◽  
Opioid Use ◽  
Opioid Substitution Therapy ◽  
Group Status ◽  
Urine Drug ◽  
Retention In Treatment

Abstract Background and Objectives Substance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD). Methods Data were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis. Results Altogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024). Discussion and Conclusions This study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.

scholarly journals A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Megan A. O’Grady ◽  
Patricia Lincourt ◽  
Belinda Greenfield ◽  
Marc W. Manseau ◽  
Shazia Hussain ◽  
...  
Keyword(s):  
Substance Use ◽  
Quality Improvement ◽  
Substance Use Disorder ◽  
Controlled Trial ◽  
Opioid Use Disorder ◽  
Treatment Quality ◽  
Opioid Use ◽  
Substance Use Disorder Treatment ◽  
Randomized Controlled ◽  
Disorder Treatment

Abstract Background The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder. Methods A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data. Discussion This study will provide the field with a strong test of a multicomponent intervention to improve providers’ capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system. Trial registration Trial #NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020

scholarly journals Development and implementation of a physician-pharmacist collaborative practice model for provision and management of buprenorphine/naloxone

2021 ◽  
Vol 11 (1) ◽  
pp. 35-39
Author(s):  
Lindsay M. Mailloux ◽  
Matthew T. Haas ◽  
Janel M. Larew ◽  
Beth M. DeJongh
Keyword(s):  
Patient Care ◽  
Medication Reconciliation ◽  
Medication Management ◽  
Pharmacist Intervention ◽  
Opioid Use Disorder ◽  
Collaborative Practice ◽  
Quality Improvement Initiative ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Access To Treatment

Abstract Introduction Physician-pharmacist collaborative practice models (PPCPM) decrease barriers and increase access to medications for opioid use disorder (MOUD) but are not routine in practice. The purpose of this quality improvement initiative is to develop and implement a PPCPM for management of patients on MOUD with buprenorphine/naloxone to minimize provider burden, expand access to treatment, and enhance overall patient care. Methods A PPCPM for management of patients on MOUD with buprenorphine/naloxone was piloted in an outpatient substance use disorder clinic. Approximately 4 hours per week were dedicated to physician-pharmacist collaborative medical appointments for a 5-month trial period. The pharmacist met with the patient first and then staffed the case with the collaborating psychiatrist. Descriptive data from PPCPM appointments was collected and compared to data from psychiatrist-only appointments. Results Twenty-five patients were seen over 44 appointments with an estimated 33 hours of psychiatrist time saved. Average initial and end buprenorphine doses, urine drug screen (UDS) results, and mental health (MH) medication interventions were similar between patients seen in PPCPM appointments compared with those seen in psychiatrist-only appointments. Collection of UDS, identification and management of MOUD adherence issues, other service referrals, and medication reconciliation intervention were more frequent in PPCPM appointments. Discussion Implementation of a PPCPM allowed for provision of a similar level of care regarding MOUD and MH-related medication management while saving psychiatrist time. Other enhancements to patient care provided through pharmacist intervention included more frequent identification and management of MOUD adherence issues, referral for other services, and medication reconciliation interventions.

Optimizing Post-Cesarean Opioid Prescription Practices at Mayo Clinic: A Quality Improvement Initiative

2021 ◽  
Author(s):  
Sharon Kim ◽  
Amanda King ◽  
Pavan Parikh ◽  
Ajleeta Sangtani ◽  
Sherif Shazly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Perception ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Post Intervention ◽  
Opioid Prescription ◽  
Outpatient Prescription ◽  
Prescription Practices ◽  
Satisfaction Measures ◽  
Prospective Longitudinal

Objective Optimal prescriptions practices of opioids in the post-cesarean period remain controversial. The primary aim of this initiative was to minimize unused prescription narcotic medication, with a goal of ≤4 leftover pills of 5-mg oxycodone at postoperative day (POD) 14 without affecting pain or satisfaction measures. Study Design This was a prospective longitudinal quality improvement (QI) initiative starting in 2017 utilizing the DMAIC methodology. The measurement phase consisted of validated surveys over 3 months, along with chart review to determine current institutional prescription practices and predictors of outpatient opioid use. Resulting recommendations were adopted, and 1 year later, all patients undergoing cesarean were surveyed for 3 months to determine the effectiveness of the intervention. The study was approved by the Department's QI Committee. Results The response rate was 48%, with 50 of 101 patients completing surveys pre-intervention and 52 of 111 post-intervention. Pre-intervention, surplus medication was predicted (p <0.05) only by the quantity of the opioid prescription. In addition, patients who required ≤37.5 morphine milligram equivalents (MMEs) during the inpatient postoperative stay did not require outpatient narcotic prescriptions. Thereafter, a strategy of matching inpatient use to outpatient prescription 1:1 in a linear regression model (p <0.001, R 2 0.55) optimally matched patient needs up to 200 MME. In the post-intervention survey, mean (SD) prescription decreased from 17.6 (13.7) MME to 8.4 (8.3) MME (p <0.01); 39% compared with 16% of women were discharged without a prescription (p <0.01); and amongst all patients 82.7% compared with 59.6% (p <0.01) had ≤4 pills remaining without differences in patient satisfaction or pain perception. Conclusion This initiative highlights a practical approach to QI utilizing industry techniques in health care. This approach resulted in significant reductions in over-prescription and unused medication, without impacting pain or satisfaction scores. Key Points

Sign in / Sign up

Export Citation Format

Share Document