Related Experiment Video
Updated: Oct 14, 2025
Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
A Facility-Wide Plan to Increase Access to Medication for Opioid Use Disorder in Primary Care and General Mental
Juliette F Spelman1, Ellen L Edens1, Susan Maya1
1is a Pr imary Care Physician; is an Addiction Psychiatrist and Substance Use Disorder Director, National TeleMental Health Center; is a Research Psychologist; is a Clinical Pharmacy Specialist in mental health (Clinical Resource Hub, Veterans Integrated Service Network 1); is a Clinical Psychologist; is a General Internist; is a Clinical Nurse Coordinator Outpatient Addiction; is an Addiction Psychiatrist; is a Primary Care Physician and National Co-Director for the Veterans Health Administration Primary Care Pain Initiative and Post Deployment Integrated Care Initiative; is an Addiction Psychiatrist and Director of Addiction Treatment programs; all at Veterans Affairs Connecticut Health Care System, in West Haven. is a Primary Care Physician at Beth Israel Deaconess Medical Center and an Instructor in Medicine at Harvard Medical School in Boston, Massachusetts. is an Investigator and Staff Psychologist at Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System and an Assistant Professor of Medicine at the University of Minnesota School of Medicine. is a Physician, Chief of Addiction Medicine, and Core Faculty at Informatics, Decision-Enhancement, and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System and a Professor of Medicine and Psychiatry and Director of the Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine in Salt Lake City. Marc Rosen is a Professor of Psychiatry; Andrea Burgo is an Assistant Clinical Professor of Medicine; Maria Garcia-Vassallo is an Assistant Professor of Psychiatry; William Becker is an Associate Professor of Medicine; Robert MacLean is an Assistant Professor of Psychiatry; Ellen Edens is an Associate Professor of Psychiatry; Juliette Spelman is an Assistant Professor of Medicine; Brent Moore is a Research Scientist; all at Yale School of Medicine in New Haven.
Background:
The opioid epidemic in the United States has generated a pressing need to enhance access to medications for opioid use disorder (MOUD). This program description illustrates a quality-improvement effort to extend MOUD to primary care and general mental health clinics within the US Department of Veterans Affairs (VA) Connecticut Healthcare system (VACHS), and to examine barriers and facilitators to implementation of MOUD in target clinics.
Observations:
As part of the national VA Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative to improve MOUD access, a VACHS team identified and resolved barriers to MOUD in target clinics. Key interventions were to obtain leadership support, increase waivered prescribers, and develop processes and tools to enhance prescribing. New initiatives included quarterly educational sessions, templated progress notes, and instant messaging for addiction specialist electronic consultations. MOUD receipt and prescriber characteristics were evaluated before and 1 year after implementation. There was a 4% increase in eligible patients receiving MOUD, from 552 (44%) to 582 (48%) (P = .04). The number of waivered prescribers increased from 67 to 131, and the number of buprenorphine prescribers increased from 35 to 52 over a 6-month span, and the percentage of health care practitioners capable of prescribing within the electronic health record increased from 75% to 89% (P = .01).
Conclusions:
An interdisciplinary team approach to identifying and overcoming barriers to MOUD target clinics expands access. Key interventions include interdisciplinary leadership engagement, proactive education and incentivization of target prescribers, removal of procedural barriers, and development of tools to facilitate and support prescribing. These concrete interventions can help inform other institutions interested in expanding MOUD access.
Related Concept Videos
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
01:02Prescription, Nonprescription and Orphan Drugs
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
01:17Healthcare Agencies II
Parish nursing is a growing specialty nursing profession that focuses on holistic healthcare, health promotion, and illness prevention. It blends professional nursing practice with a health ministry, focusing on health and healing within the context of a Christian community. Parish nurses serve as health educators, referral sources,...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:21Planning Nursing Care I
01:28Drug Therapy
Antianxiety Medications