Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers

Cochran, Gerald; Cole, Evan S.; Warwick, Jack; Donohue, Julie M.; Gordon, Adam J.; Gellad, Walid F.; Bear, Todd; Kelley, David; DiDomenico, Ellen; Pringle, Jan

doi:10.1186/s13722-019-0154-4

Cited by 14 publications

(13 citation statements)

References 28 publications

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“…Additionally, since this research was conducted in New York City participants likely had better access to MMT than in less urban geographic areas. Research has demonstrated the dearth of services for people who use illegal drugs in non-urban settings ( Jones, 2018 ; Cochran et al, 2019 ). Similarly, because of the clustering of harm reduction services in urban locations, participation in MMT is probably less stigmatizing than in other settings.…”

Section: Discussionmentioning

confidence: 99%

“I’m Going to Stop Myself Before Someone Stops Me”: Complicating Narratives of Volitional Substance Use Treatment

Frank

Walters

2021

Front. Sociol.

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Background: Often people assume that entry into drug treatment is a voluntary action for persons who use drugs (PWUD). This narrative informs the organizational and regulatory structure of most treatment programs and consequently affects patients’ ability to exert agency over their own treatment. Yet, this view ignores the complex interplay between individual and structural factors in peoples’ decision-making processes, particularly among people who use drugs who are stigmatized and criminalized. Treatment programs that assume voluntary entry may lack appropriate services for the populations of treatment seekers that they serve.Methods: This paper uses semi-structured interviews with 42 participants in Opioid Substitution Treatment (OST) (including patients, clinic doctors and staff, and advocates) informed by one of the author’s own lived experience in OST, to examine patients’ treatment decisions, and in particular, if and how, the structural context of drugs’ illegality/criminalization affected their willingness to pursue treatment. A Critical Discourse Analysis was used to identify key themes.Results: Interview data demonstrates that most people who use drugs enter treatment under constrained conditions related to drugs’ illegality. Themes that emerged included: 1. A feeling of limited choices due to drugs’ illegality; 2. Peer and family pressure; 3. Fear of losing children; and 4. Internalized stigma (i.e. feeling they are dirty or bad for using).Conclusion: Narratives that frame PWUD’s treatment decisions as volitional provide political cover to policies that criminalize PWUD by obscuring their effect on PWUD’s treatment decisions. Treatment models, particularly those that serve highly criminalized populations, should be re-conceptualized outside of normative narratives of individual choice, and be broadened to understand how larger structures constrain choices. By looking at macro-level factors, including the interplay of criminalization and drug treatment, programs can begin to understand the complexity of PWUD motivations to enter drug treatment. Recognizing the role of the War on Drugs as a force of oppression for people who use drugs, and that their treatment decisions are made within that setting, may enable people in treatment, and providers, to develop more productive ways of interacting with one another. Additionally, this may lead to better retention in treatment programs.

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Section: Discussionmentioning

confidence: 99%

“I’m Going to Stop Myself Before Someone Stops Me”: Complicating Narratives of Volitional Substance Use Treatment

Frank

Walters

2021

Front. Sociol.

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“…One of the biggest challenges to date with increased buprenorphine prescribing for OUD remains financial concerns over insurance coverage, increased costs, and Medicaid reimbursement [29][30][31]. Evidence shows that increases in the price of buprenorphine/naloxone have the most pronounced negative effects on rural patients and patients from the south [29].…”

Section: Current State Changes and Challenges Of Buprenorphine Prescribing In Rural Areasmentioning

confidence: 99%

“…Along with this new legislation, improved insurance compensation must occur, and insurers should be encouraged to cover MOUD costs for longer periods and be discouraged from increasing out-of-pocket costs. Increased financial support from federal Medicaid and state-level Medicaid Managed Care Organizations (MCOs) should be pursued as it can improve access to MOUD for several rural patients and help them achieve and sustain sobriety [31]. In addition to this major financial barrier, other challenges shared by rural physicians are lack of a physician support network, lack of adequate clinic staff who were trained on caring for patients with OUD, a need to address mental health concerns through additional counseling, time restraints, legal regulations, stigma, and concerns over buprenorphine diversion [30,[32][33][34][35].…”

Section: Current State Changes and Challenges Of Buprenorphine Prescribing In Rural Areasmentioning

confidence: 99%

“…Additionally, concerns over Medicaid coverage continue to rise. Medicaid is the largest source of third-party coverage for rural patients with OUD and provides coverage for nearly 40% of patients with OUD in the United States [ 30 , 31 ]. Physicians who prescribe buprenorphine for the treatment of OUD report that they often had difficulty in getting patients who were covered by Medicaid approved for reimbursement.…”

Section: Reviewmentioning

confidence: 99%

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Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Gregory¹,

Hill²,

Parker³

2021

Cureus

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Buprenorphine/Naloxone (Suboxone®) is an efficacious treatment for opioid use disorder (OUD) due to its more convenient dosing, superior safety profile, and decreased incidence of negative side effects when compared to other forms of medications for opioid use disorder (MOUD). In the United States, updated legislation in 2021 entitled, "The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder", released by the Department of Health and Human Services, creates an exemption for the previously required Drug Addiction Treatment Act of 2000 (DATA) waiver for buprenorphine prescribing for clinicians. This legislation was born out of a need for making MOUD more accessible for patients living with OUD as rates of opioid-related deaths in the United States have continued to rise and have increased disproportionately during the time period of the COVID-19 pandemic. This legislation has the potential to improve access to MOUD across all geographic locations, but may have the most profound impact in rural areas where significant disparities and challenges still exist in patients’ ability to access buprenorphine. The purpose of this literature review is to 1) examine how MOUD prescribing has changed after previous legislation changes, 2) explore the current state of buprenorphine access for treatment of OUD in rural America, 3) detail existing barriers in patients' ability to access MOUD, and 4) discuss future directions and considerations as a result of new legislation. This literature review found several existing barriers to receiving MOUD such as increasing costs, insufficient education, significant stigma, and the need for more innovative methods of delivery. We also found that there is currently a large opportunity for growth in the number of rural clinicians able to prescribe buprenorphine, particularly in primary care, that may now occur as a result of this new legislation. Overall, this legislation has the potential to have a positive impact on combating OUD, especially in rural areas, and may be a critical step towards ending the current opioid epidemic in the United States as these described barriers are addressed.

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“…It may be attributed to many reasons including lack of instruments and trained specialist surgeons. 8,9 There are many studies on the laparoscopic cholecystectomy in rural hospitals. It is important to understand whether the advantages of the laparoscopic cholecystectomy are there in the rural hospital set up.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of laparoscopic cholecystectomy in rural hospitals – A systematic review

2021

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There are many studies on the laparoscopic cholecystectomy in rural hospitals. It is important to understand whether the advantages of the laparoscopic cholecystectomy are there in the rural hospital set up. The present systematic review of literature aims to find the various outcomes of laparoscopic cholecystectomy in rural hospitals. The study was conducted based on PRISMA guidelines for systematic reviews. The MEDLINE and EMBASE database were used the retrieve the articles. A detailed descriptive analysis was on the various outcomes of open and laparoscopic cholecystectomy. The present systematic review has identified that the laparoscopic cholecystectomy in rural hospitals is most preferred as that of urban setting. It not only provides less hospital stay, but also provides economical option for rural patients. However, there are some limitations in many rural settings like lack of instrumental facility and trained surgeon. The outcomes of the laparoscopic cholecystectomy in some rural hospitals are comparatively same as that of urban settings.

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Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers

Cited by 14 publications

References 28 publications

“I’m Going to Stop Myself Before Someone Stops Me”: Complicating Narratives of Volitional Substance Use Treatment

“I’m Going to Stop Myself Before Someone Stops Me”: Complicating Narratives of Volitional Substance Use Treatment

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Outcomes of laparoscopic cholecystectomy in rural hospitals – A systematic review

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