Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana

Green, Brandn; Rhubart, Danielle; Filteau, Matthew R.

doi:10.1177/11782218211039781

Cited by 10 publications

(14 citation statements)

References 20 publications

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“…Such concerns echo financial, infrastructural, and geographic issues documented in the evolving literature on such programs. 42,43 Similarly, there have been substantial efforts to encourage linkage to MOUD for individuals being treated in emergency departments, with several states seeking to support such initiatives. 44,45 The panelists also raised questions about the feasibility of such approaches because of coordination and infrastructure complexities.…”

Section: Discussionmentioning

confidence: 99%

Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder

et al. 2022

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ImportanceIn the US, recent legislation and regulations have been considered, proposed, and implemented to improve the quality of treatment for opioid use disorder (OUD). However, insufficient empirical evidence exists to identify which policies are feasible to implement and successfully improve patient and population-level outcomes.ObjectiveTo examine expert consensus on the effectiveness and the ability to implement state-level OUD treatment policies.Evidence ReviewThis qualitative study used the ExpertLens online platform to conduct a 3-round modified Delphi process to convene 66 stakeholders (health care clinicians, social service practitioners, addiction researchers, health policy decision-makers, policy advocates, and persons with lived experience). Stakeholders participated in 1 of 2 expert panels on 14 hypothetical state-level policies targeting treatment engagement and linkage, evidence-based and integrated care, treatment flexibility, and monitoring or support services. Participants rated policies in round 1, discussed results in round 2, and provided final ratings in round 3. Participants used 4 criteria associated with either the effectiveness or implementability to rate and discuss each policy. The effectiveness panel (n = 29) considered policy effects on treatment engagement, treatment retention, OUD remission, and opioid overdose mortality. The implementation panel (n = 34) considered the acceptability, feasibility, affordability, and equitability of each policy. We measured consensus using the interpercentile range adjusted for symmetry analysis technique from the RAND/UCLA appropriateness method.FindingsBoth panels reached consensus on all items. Experts viewed 2 policies (facilitated access to medications for OUD and automatic Medicaid enrollment for citizens returning from correctional settings) as highly implementable and highly effective in improving patient and population-level outcomes. Participants rated hub-and-spoke–type policies and provision of financial incentives to emergency departments for treatment linkage as effective; however, they also rated these policies as facing implementation barriers associated with feasibility and affordability. Coercive policies and policies levying additional requirements on individuals with OUD receiving treatment (eg, drug toxicology testing, counseling requirements) were viewed as low-value policies (ie, decreasing treatment engagement and retention, increasing overdose mortality, and increasing health inequities).Conclusions and RelevanceThe findings of this study may provide urgently needed consensus on policies for states to consider either adopting or deimplementing in their efforts to address the opioid overdose crisis.

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Section: Discussionmentioning

confidence: 99%

Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder

et al. 2022

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“…First responders in this study respond to these shortcomings by describing a lack of access to treatment and harm reduction services throughout Montana. Structural barriers constrain Montana’s ability to expand medication for opioid use disorder (see [ 34 ]), prompting calls for a more robust harm reduction strategy that compensates for the state’s insufficient treatment capacity [ 12 ]. One method that could reduce these structural barriers and improve layperson access to naloxone is the implementation of a mail-order naloxone program [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

“…National data from 2018 showed that too few (only 42%) substance use treatment providers offered medication for opioid use disorder (US Substance Abuse and Mental Health Services Administration, 2019), and many treatment options were concentrated in urban areas, which resulted in long wait times for admission and an increased risk of overdose for rural patients [ 2 , 34 , 57 , 64 ]. Previous studies suggest that a stronger connection to treatment and recovery services can bolster harm reduction efforts [ 71 , 76 , 37 ]; however, first responders located in the most remote and developed areas of Montana reported serving residents across vast geographic distances and expressed frustration with the lack of addiction treatment resources and lengthy waitlists that limit access to treatment for Montanans (also see [ 13 , 30 , 60 ]).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies suggest that a stronger connection to treatment and recovery services can bolster harm reduction efforts [ 71 , 76 , 37 ]; however, first responders located in the most remote and developed areas of Montana reported serving residents across vast geographic distances and expressed frustration with the lack of addiction treatment resources and lengthy waitlists that limit access to treatment for Montanans (also see [ 13 , 30 , 60 ]). Expanding harm reduction approaches, like training laypersons to administer naloxone, residents’ best chance to reverse and survive an opioid overdose due to the persistent lack of treatment services in FAR states [ 2 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…The present study examines first responders’ perceptions of take-home NRKs for laypeople in Montana, a state with numerous Frontier and Remote (FAR) areas. This study adds to the literature by examining first responders’ perceptions of expanding naloxone access to laypeople in a state with FAR areas that lack MOUD treatment and mental health care options [ 2 , 34 , 64 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

‘It’s the same thing as giving them CPR training’: rural first responders’ perspectives on naloxone

Filteau¹,

Green²,

Kim³

et al. 2022

Harm Reduct J

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The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders’ inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area’s overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents’ best chance for surviving an opioid overdose.

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Refining the Implementation of a Hub-and-Spoke Model for TelePain Through Qualitative Inquiry

Subramaniam

Chen

Wilkerson

et al. 2022

J. technol. behav. sci.

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The hub-and-spoke telehealth model leverages centrally located providers who utilize telehealth technology to bring specialized care to medically underserved areas. This model has the potential to promote equitable access to healthcare. However, few studies address how to facilitate the adoption and implementation of hub-and-spoke telehealth. We examined spoke site providers’ experiences with TelePain, a national hub-and-spoke model of interdisciplinary chronic pain care, with a focus on improving future implementation. We conducted semi-structured individual interviews (20–45 min) with 27 VA spoke site providers via teleconferencing between August 2020 and February 2021. Interview transcripts were coded in Atlas.ti 8.0 using deductive (identified a priori and used to build the interview guide) and inductive (emerging) codes. Our analysis identified the following themes stressed by the spoke sites: (1) spoke sites needed to envision how TelePain services would work at their site before deciding to adopt; (2) TelePain implementation needed to fit into local existing care processes; (3) hub sites needed to understand spoke sites’ context (e.g., via needs assessment) to tailor the services accordingly, and (4) hub-and-spoke sites needed to establish bidirectional communication. Our findings provide a practical guide to improve future rollout of hub-and-spoke telehealth models. Recommendations focus on the role of the hub site in promoting program adoption by (1) developing a clear and detailed marketing plan and (2) considering how the program can be adapted to fit the local spoke site context. To improve implementation, hub-and-spoke sites must establish ongoing and consistent bidirectional communication; this is particularly critical in the everchanging post-peak pandemic healthcare system. An important next step is the development of recommendations and guidelines for implementing hub-and-spoke telehealth, as well as examining pain outcomes for patients touched by this program.

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Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana

Cited by 10 publications

References 20 publications

Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder

Expert Panel Consensus on State-Level Policies to Improve Engagement and Retention in Treatment for Opioid Use Disorder

‘It’s the same thing as giving them CPR training’: rural first responders’ perspectives on naloxone

Refining the Implementation of a Hub-and-Spoke Model for TelePain Through Qualitative Inquiry

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