Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders

Abstract

Objectives Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont. Methods We initiated a learning collaborative with 4 cohorts of physician practices (28 total practices). The learning collaborative consisted of a series of 4 face-to-face and 5 teleconference sessions over 9 months. Practices collected and reported on 8 quality-improvement data measures, which included the number of patients prescribed buprenorphine, and the percent of unstable patients seen weekly. Changes from baseline to 8 months were examined using a p-chart and logistic regression methodology. Results Physician engagement in the learning collaborative was favorable across all 4 cohorts (85.7%). On 6 of the 7 quality-improvement measures, there were improvements from baseline to 8 months. On 4 measures, these improvements were statistically significant (P < 0.001). Importantly, practice variation decreased over time on all measures. The number of patients receiving medication increased only slightly (3.4%). Conclusions Results support the effectiveness of a learning collaborative approach to engage physicians, modestly improve patient access, and significantly reduce practice variation. The strategy is potentially generalizable to other systems and regions struggling with this important public health problem.

Why aren't physicians prescribing more buprenorphine?

“…This model links primary care providers with larger OMT programs to provide support and guidance for patient management, and providers a nurse and case manager for primary care clinics (Simpatico, 2015). Together with alearning collaborative (Nordstorm et al, 2016), the: hub-and-spoke approach has shown demonstrable gains in engaging physicians and increasing buprenorphine adoption. A second approach is use of telemedicine or teleconsultation to link inexperienced providers with mentors to help navigate buprenorphine OMT procedures.…”

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

“…To support state-wide dissemination and implementation of the hub-and-spoke model and establish consistency in all practices, a learning collaborative was developed (Nordstrom et al, 2016). It offers in-person and web-based lectures to spoke physicians and MAT staff covering safe prescribing, use of evaluation tools, treatment plan development, responses to relapse, patient noncompliance, and diversion control.…”

Implementing Treatment of Opioid-Use Disorder in Rural Settings: a Focus on HIV and Hepatitis C Prevention and Treatment

“…In addition, teams were developed that were comprised generally of a nurse and behavioral health specialist that support the clinicians by conducting patient intakes/assessments and then manages many other ongoing treatment activities (e.g., delivers counseling, arranges for urine toxicology testing). Finally, a centralized learning collaborative has been developed that offers ongoing training on evidence-based practices [81]. The opportunity to develop and sustain this model of care is the result of forward-thinking state legislation working closely with clinical experts along with a favorable insurance/Medicaid landscape in Vermont.…”