Integrating Opioid Use Disorder Treatment Into Primary Care Settings

Area of Science:

• Implementation Science
• Primary Care Medicine
• Addiction Psychiatry

Background:

• Medication for opioid use disorder (MOUD) is crucial for treating opioid use disorder (OUD).
• Primary care settings offer a promising venue for MOUD delivery, but implementation barriers persist.
• Multidisciplinary primary care (PC) teams are key to integrating MOUD services.

Purpose of the Study:

• To evaluate an implementation intervention aimed at supporting PC teams in initiating or expanding MOUD.
• To explore the experiences and perspectives of PC teams regarding MOUD implementation over two years.
• To identify multilevel factors influencing the provision of MOUD within diverse PC settings.

Main Methods:

• A hybrid effectiveness-implementation study utilizing a survey-based and ethnographic qualitative design.
• Involved 12 diverse PC clinics and their multidisciplinary teams (prescribing clinicians, behavioral health care managers, psychiatrists).
• Employed quantitative surveys and qualitative field notes from implementation meetings, analyzed descriptively and using rapid assessment methods.

Main Results:

• Analysis of 62 survey respondents and 362 implementation meetings revealed four themes.
• Key challenges included clinical administrative logistics, limited rapid access to care, patient engagement difficulties, and clinician confidence issues.
• Conflicting attitudes among PC teams regarding MOUD expansion were also identified, with variations across clinics.

Conclusions:

• PC teams require flexible scheduling and enhanced patient engagement strategies for effective MOUD delivery.
• Ongoing training is essential to maintain clinician confidence in managing evolving OUD clinical issues.
• Addressing structural challenges like workload burden and schedule inflexibility is critical for expanding MOUD in primary care.