Adoption of Evidence-Based Clinical Innovations

Abstract

This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and characteristics of staff; organizations’ technical and social support for the innovation; local market dynamics and competition; and state policies governing the innovation. Results indicate that buprenorphine use increased 24% for detoxification and 47% for maintenance therapy between 2005 and 2011. Buprenorphine use was positively related to reliance on private insurance and availability of state subsidies to cover its cost and inversely related to the percentage of clients who injected opiates, county size, and local availability of methadone. The results indicate that financial incentives and market factors play important roles in opioid treatment programs’ decisions to adopt evidence-based clinical innovations such as buprenorphine use.

Utilization and outcomes of detoxification and maintenance treatment for opioid dependence in publicly-funded facilities in California, USA: 1991–2012

“…PO and heroin co-use is less understood. Heroin users may also use POs to treat chronic pain (Jones, 2013), while primary PO users may transition to heroin use (Andrews et al, 2014); the former hypothesis may be consistent with our findings.…”

“…It is unclear the extent to which individuals using DTCs transition to office-based buprenorphine treatment and vice-versa; in general, utilization and outcomes of office-based treatment with buprenorphine are under-studied. It has been suggested that office-based providers service a distinct population of generally higher socioeconomic status (Andrews et al, 2014). Finally, the long-term outcomes of treatment, including morbidity, mortality and criminality are beyond the scope of this manuscript, and the subject of future inquiry within this patient population.…”

Quality of life as an outcome of opioid use disorder treatment: A systematic review

“…As a result, new policy efforts are being directed towards opioid use disorders (Blendon, McMurtry, Benson, & Sayde, 2016; Office of the Press Secretary, 2016) and the number of evidence-based therapies to address opioid use disorders is increasing (Amato et al, 2005; Brooks et al, 2010; Campbell et al, 2012; Carpenter et al, 2009; Mattick, Breen, Kimber, & Davoli, 2014; Sullivan et al, 2006). Treatment programs are increasingly adopting many of these therapies (Andrews, D’Aunno, Pollack, & Friedmann, 2014) and program evaluations suggest they are effective in helping clients achieve and maintain abstinence (Sheehan, Oppenheimer, & Taylor, 1993; Wittchen et al, 2008). …”

Lessons From Medicaid’s Divergent Paths On Mental Health And Addiction Services

“…Assessment and treatment of addiction treatment has been less well integrated into primary care, in part as a result of restrictions on prescribing of addiction medications. 40 …”