Background Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers’ perceptions about MOUD over the first year of implementation. Methods Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach. Results Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents’ ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time. Conclusions Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers’ and clinical leaders’ perceptions of MOUD over time. Strategies that improve leaders’ prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.

This quality improvement study assesses whether a Veterans Affairs initiative was associated with increased prescribing of medications for opioid use disorder.

BackgroundRelations between impulsigenic traits and alcohol-related outcomes have been the focus of much research, yet precise relations remain elusive. Historically, research used broadband conceptualizations of impulsivity, which yielded inconclusive findings. Attempts to ameliorate this problem led to more work on narrowband assessments of impulsivity. Despite that several narrowband self-report measures exist, few demonstrate adequate psychometric properties. Given the limits of self-report, researchers have also utilized laboratory-based measures of impulsive dispositions; however, this seems to have contributed more uncertainty to the literature.ReviewWe review commonly used self-report and laboratory-based measures of narrowband impulsivity, as well as assessments of alcohol-related constructs (e.g., consumption and consequences). We discuss remaining issues in impulsivity and alcohol assessment, which limit understanding of how impulsigenic traits influence alcohol-related behaviors. Cutting-edge conceptualizations and assessment of state-level impulsivity are also discussed.ConclusionsMore work is necessary to further this area of research, including establishing consistent nomenclature and a cohesive conceptualization of impulsigenic traits as they relate to alcohol use and alcohol use disorders.

The National Institutes of Health's (NIH) PhenX Toolkit has recognized the UPPS-P Impulsive Behavior Scale as a recommended measure of impulsive dispositions, as this framework for impulsivity-like traits has demonstrated strong psychometric properties across a variety of samples and exhibited measurement and structural invariance across males and females. Impulsivity-like facets, as assessed by this measure, have also demonstrated robust relations to alcohol and substance use. However, racial and ethnic differences in impulsivity have largely been neglected in the literature. Thus, the current study sought to test measurement invariance on the UPPS-P across Hispanic/Latino and non-Hispanic/Latino college students and determine whether ethnicity moderates the relations between impulsivity-like facets and alcohol and other substance use endorsement. Results indicated that the UPPS-P is invariant between groups in this sample, which suggests that scale scores on this measure can be reliably compared across Hispanic/Latino and non-Hispanic/Latino individuals. There were no significant differences in impulsivity-like facets across groups; however, non-Hispanic/Latino individuals who were higher in sensation seeking exhibited increased log-odds of endorsing past-month smokeless tobacco use. Finally, impulsivity-like facets were significantly and differentially related to substance use outcomes, which support findings from previous studies. This research highlights the importance of examining impulsivity-like traits and substance use among Hispanic/Latino individuals, and provides evidence that the UPPS-P can be reliably and validly interpreted when testing differences between Hispanic/Latino and non-Hispanic/Latino groups. (PsycINFO Database Record