Implementing Group Visits for Opioid Use Disorder: A Case Series

Abstract

Background: Group-based models of Office-Based Opioid Treatment with buprenorphine-naloxone (B/N) are increasingly being implemented in clinical practice to increase access to care and provide additional therapeutic benefits. While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings. Case series: We present 4 cases of GBOT implementation across a large academic health care system, highlighting various potential approaches for providers who seek to implement GBOT and demonstrate “success” based on feasibility and sustainability of these models. For each case, we describe the pros and cons and detail the personnel and resources involved, patient mix and group format, workflow logistics, monitoring and management, and sustainability components. Discussion: The implementation details illustrate that there is no one-size-fits-all approach, although feasibility is commonly supported by a team-based, patient-centered medical home. This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system. Future research identifying the core and malleable components to implementation, their evidence base, and how they might be influenced by site-specific resources, culture, and other contextual factors can help providers better understand how to implement a GBOT model in their unique clinical environment.

Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial

“…2 ): (1) believes higher level of care is not needed ( n =11); (2) personal logistical issues ( n =5); (3) disinterest in research participation ( n = 4); (4) lost contact ( n =4); (5) no reason specified ( n =1). People who declined the study generally wished to continue primary care B/N treatment or group-based opioid treatment only ( Sokol et al., 2020 , 2019 , 2018 ) without additional coaching or daily monitoring of medication adherence. Many people referred by their provider for supervised dosing due to their prescriber's adherence concerns, did not feel they had an issue with medication adherence, nor did they feel a need for supervised dosing.…”

Effects of a trauma‐informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof‐of‐concept study

“…M‐ROCC is a motivationally‐sensitive, trauma‐informed Mindfulness‐Based OUD Care Continuum seeking to facilitate addiction recovery by offering mindfulness group training integrated within the Group‐Based Opioid Treatment model to help patients cope with experiences of stress, anxiety, depression, pain, craving, and addictive habit patterns 31,32 . The M‐ROCC curriculum has three primary components: Low Dose Mindfulness (LDM) introduction group, Mindfulness Training for Primary Care—OUD (MTPC‐OUD) intensive group, and Mindfulness Maintenance Check‐in Support (MCS).…”

A Change Management Case Study for Safe Opioid Prescribing and Opioid Use Disorder Treatment

“…We also created a structure to improve the management of patients with OUD by creating an interdisciplinary team comprising a physician, physician assistant, nurse, an appointment scheduler, medical assistant, and psychotherapist to provide group-based opioid treatment (GBOT) as the primary treatment approach to OUD [17][18][19] and to provide oversight and support to all providers. All patients diagnosed with OUD were referred to this GBOT team for initial treatment.…”