Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Study protocol

Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial

Authors: Todd Molfenter, Hannah K. Knudsen, Randy Brown, Nora Jacobson, Julie Horst, Mark Van Etten, Jee-Seon Kim, Eric Haram, Elizabeth Collier, Sanford Starr, Alexander Toy, Lynn Madden

Published in: Implementation Science | Issue 1/2017

Login to get access

Abstract

Background

Overdoses due to non-medical use of prescription opioids and other opiates have become the leading cause of accidental deaths in the USA. Buprenorphine and extended-release naltrexone are key evidence-based pharmacotherapies available to addiction treatment providers to address opioid use disorder (OUD) and prevent overdose deaths. Treatment organizations’ efforts to provide these pharmacotherapies have, however, been stymied by limited success in recruiting providers (physicians, nurse practitioners, and physician assistants) to prescribe these medications. Historically, the addiction treatment field has not attracted physicians, and many barriers to implementing OUD pharmacotherapy exist, ranging from lack of confidence in treating OUD patients to concerns regarding reimbursement. Throughout the USA, the prevalence of OUD far exceeds the capacity of the OUD pharmacotherapy treatment system. Poor access to OUD pharmacotherapy prescribers has become a workforce development need for the addiction treatment field and a significant health issue.

Methods

This cluster randomized controlled trial (RCT) is designed to increase buprenorphine and extended-release naltrexone treatment capacity for OUD. The implementation intervention to be tested is a bundle of OUD pharmacotherapy capacity building practices called the Prescriber Recruitment Bundle (PRB), which was developed and piloted in a previous statewide buprenorphine implementation study. For this cluster RCT, organizational sites will be recruited and then randomized into one of two arms: (1) control, with treatment as usual and access to a website with PRB resources, or (2) intervention, with organizations implementing the PRB using the Network for the Improvement of Addiction Treatment organizational change model over a 24-month intervention period and a 10-month sustainability period. The primary treatment outcomes for each organizational site are self-reported monthly counts of buprenorphine slots, extended-release naltrexone capacity, number of buprenorphine patients, and number of extended-release naltrexone patients.
This trial will be conducted in Florida, Ohio, and Wisconsin, resulting in 35 sites in each arm, for a total sample size of 70 organizations.

Discussion

This study addresses three issues of substantial public health significance: (1) the pressing opioid misuse epidemic, (2) the low uptake of OUD treatment pharmacotherapies, and (3) the need to increase prescriber participation in the addiction treatment workforce.

Trial registration

ClinicalTrials.gov NCT02926482,
Literature
1.
Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999-2011. NCHS Data Brief. 2014;166:1–8.
2.
Berglund M. A better widget? Three lessons for improving addiction treatment from a meta-analytical study. Addiction. 2005;100(6):742–50.CrossRefPubMed
3.
Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207.
4.
Krupitsky E, Zvartau E, Blokhina E, Verbitskaya E, Wahlgren V, Tsoy-Podosenin M, et al. Randomized trial of long-acting sustained-release naltrexone implant vs oral naltrexone or placebo for preventing relapse to opioid dependence. Arch Gen Psychiatry. 2012;69(9):973–81.CrossRefPubMedPubMedCentral
5.
Ling W, Charuvastra C, Collins JF, Batki S, Brown LS Jr, Kintaudi P, et al. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 1998;93(4):475–86.CrossRefPubMed
6.
Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.CrossRefPubMedPubMedCentral
7.
8.
Comer SD, Sullivan MA, Yu E, Rothenberg JL, Kleber HD, Kampman K, et al. Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2006;63(2):210–8.CrossRefPubMedPubMedCentral
9.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2014 National Survey on Drug Use and Health: detailed tables - 5.1 to 5.56. Rockville: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2015. Available at: https://​www.​samhsa.​gov/​data/​sites/​default/​files/​NSDUH-DetTabs2014/​NSDUH-DetTabs2014.​pdf
10.
Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment Episode Data Set (TEDS): 2004–2014. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-84, HHS Publication No. (SMA) 16–4986. Rockville: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2016. Available at: https://​wwwdasis.​samhsa.​gov/​dasis2/​teds_​pubs/​2014_​teds_​rpt_​natl.​pdf
11.
Molfenter T. The pressing shortage of buprenorphine prescribers and the pending role of telemedicine. Addict Sci Clin Pract. 2015;10(Suppl 1):A40.CrossRefPubMedCentral
12.
Hutchinson E, Catlin M, Andrilla CH, Baldwin LM, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12(2):128–33.CrossRefPubMedPubMedCentral
13.
DeFlavio JR, Rolin SA, Nordstrom BR, Kazal LA Jr. Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians. Rural Remote Health. 2015;15:3019.PubMed
14.
Andrilla CHA, Coulthard C, Larson EH. Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Ann Fam Med. 2017;15(4):359–62.CrossRefPubMed
15.
Huhn AS, Dunn KE. Why aren’t physicians prescribing more buprenorphine? J Subst Abus Treat. 2017;78:1–7.CrossRef
16.
Johnson CA. CARA: policy designed to prevent & effectively treat heroin addiction through multidimensional strategies. Cleveland: Cleveland State University School of Social Work; 2016.
17.
Molfenter T, Sherbeck C, Zehner M, Starr S. Buprenorphine prescribing availability in a sample of Ohio specialty treatment organizations. J Addict Behav Ther Rehabil. 2015;4:2.
18.
Stein BD, Gordon AJ, Dick AW, Burns RM, Pacula RL, Farmer CM, et al. Supply of buprenorphine waivered physicians: the influence of state policies. J Subst Abus Treat. 2015;48(1):104–11.CrossRef
19.
Klein KJ, Conn AB, Sorra JS. Implementing computerized technology: an organizational analysis. J Appl Psychol. 2001;86(5):811–24.CrossRefPubMed
20.
Tremblay MA, Blanchard CM, Taylor S, Pelletier LG, Villeneuve M. Work extrinsic and intrinsic motivation scale: its value for organizational psychology research. Can J Behav Sci. 2009;41(4):213–26.CrossRef
21.
Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, et al. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. SGIM Career Satisfaction Study Group. Society of General Internal Medicine. Med Care 1999;37(11):1140-1154.
22.
Warner M, Hedegaard H, Chen L. Trends in drug-poisoning deaths involving opioid analgesics and heroin: United States, 1999–2012. NCHS Health E-Stat; 2014.
23.
Centers for Disease Control and Prevention (CDC). Vital signs: opioid painkiller prescribing; 2014. https://​www.​cdc.​gov/​vitalsigns/​opioid-prescribing/​.​ Accessed 14 Aug 2017.
24.
Rosenblatt RA, Andrilla CH, Catlin M, Larson EH. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015;13(1):23–6.CrossRefPubMedPubMedCentral
25.
United States Code Title 21, Chapter 13, Subchapter I, Part C, Sec. 823(g).
26.
Fleming M, Barry K, Davis A, Kahn R, Rivo M. Faculty development in addiction medicine: project SAEFP, a one-year follow-up study. Family Med. 1994;26(4):221–5.
27.
Molfenter T, Sherbeck C, Zehner M, Quanbeck A, McCarty D, Kim JS, et al. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy. 2015;10(1):13.CrossRefPubMedPubMedCentral
28.
LaBelle CT, Han SC, Bergeron A, Samet JH. Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers. J Subst Abus Treat. 2016;60:6–13.CrossRef
29.
Lofwall MR, Wunsch MJ, Nuzzo PA, Walsh SL. Efficacy of continuing medical education to reduce the risk of buprenorphine diversion. J Subst Abus Treat. 2011;41(3):321–9.CrossRef
30.
Soumerai SB, Avorn J. Principles of educational outreach (‘academic detailing’) to improve clinical decision making. JAMA. 1990;263(4):549–56.CrossRefPubMed
31.
Goldstein MG, Niaura R, Willey C, Kazura A, Rakowski W, DePue J, et al. An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project. Prev Med. 2003;36(2):185–96.CrossRefPubMed
32.
Honigfeld L, Chandhok L, Spiegelman K. Engaging pediatricians in developmental screening: the effectiveness of academic detailing. J Autism Dev Disord. 2012;42(6):1175–82.CrossRefPubMed
33.
Young LB. Telemedicine interventions for substance-use disorder: a literature review. J Telemed Telecare. 2012;18(1):47–53.CrossRefPubMed
34.
Marsch LA, Borodovsky JT. Technology-based interventions for preventing and treating substance use among youth. Child Adolesc Psychiatr Clin N Am. 2016;25(4):755–68.CrossRefPubMedPubMedCentral
35.
36.
Aarons GA, Green AE, Trott E, Willging CE, Torres EM, Ehrhart MG, et al. The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: a mixed-method study. Admin Pol Ment Health. 2016;43(6):991–1008.CrossRef
37.
Chapman DS, Uggerslev KL, Carroll SA, Piasentin KA, Jones DA. Applicant attraction to organizations and job choice: a meta-analytic review of the correlates of recruiting outcomes. J Appl Psychol. 2005;90(5):928–44.CrossRefPubMed
38.
McCarty D, Gustafson DH, Wisdom JP, Ford J, Choi D, Molfenter T, et al. The Network for the Improvement of Addiction Treatment (NIATx): enhancing access and retention. Drug Alcohol Depend. 2007;88(2):138–45.CrossRefPubMed
39.
Hoffman KA, Ford JH, Choi D, Gustafson DH, McCarty D. Replication and sustainability of improved access and retention within the Network for the Improvement of Addiction Treatment. Drug Alcohol Depend. 2008;98(1–2):63–9.CrossRefPubMedPubMedCentral
40.
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academies Press (US); 2001.
41.
Rosenthal R, Rubin DB. A simple, general purpose display of magnitude of experimental effect. J Educ Psychol. 1982;74(2):166.CrossRef
42.
Hsieh FY, Lavori PW, Cohen HJ, Feussner JR. An overview of variance inflation factors for sample-size calculation. Eval Health Prof. 2003;26(3):239–57.CrossRefPubMed
43.
Raudenbush SW, Liu X. Statistical power and optimal design for multisite randomized trials. Psychol Methods. 2000;5(2):199–213.CrossRefPubMed
44.
Burke WW, Litwin GH. A causal model of organizational performance and change. In: Burke WW, Lake DG, Paine JW, editors. Organizational change: a comprehensive reader. San Francisco: Jossey-Bass; 2009. p. 273–99.
45.
46.
Singer JD, Willett JB. Applied longitudinal data analysis: modeling change and event occurrence. New York: Oxford University Press; 2003.CrossRef
47.
MacKinnon DP. Introduction to statistical mediation analysis. New York: Lawrence Erlbaum Associates; 2008.
48.
Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15(4):309–34.CrossRefPubMed
49.
Tingley D, Yamamoto T, Hirose K, Keele L, Imai K. Mediation: R package for causal mediation analysis. J Stat Softw. 2014;59(5):1–39.CrossRef
50.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
51.
Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. 2nd ed. New York: Aldine Transaction; 1999.
52.
Schatzman L. Dimensional analysis: notes on an alternative approach to the grounding of a theory in qualitative research. In: Strauss AL, Maines DR, editors. Social organization and social process: essays in honor of Anselm Strauss. New York: Aldine De Gruyter; 1991.
53.
Caron CD, Bowers BJ. Methods and application of dimensional analysis: a contribution to concept and knowledge development in nursing. In: Rodgers B, Knafl K, editors. Concept development in nursing: foundations, techniques, and applications. 2nd ed. Philadelphia: W.B. Saunders; 2000. p. 285–319.
54.
Strauss AL. Qualitative research for social scientists. Cambridge: Cambridge University Press; 1987.CrossRef
55.
56.
Wilson B, Cohen A. The big book of alcoholics anonymous (including 12 steps, guides & prayers). CreateSpace Independent Publishing Platform; 2015.
57.
Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang CN, Jones K, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949–58.CrossRefPubMed
58.
Horgan CM, Reif S, Hodgkin D, Garnick DW, Merrick EL. Availability of addiction medications in private health plans. J Subst Abus Treat. 2008;34(2):147–56.CrossRef
59.
Schroeder SA. An agenda to combat substance abuse. Health Aff. 2005;24(4):1005–13.CrossRef
60.
Substance Abuse and Mental Health Services Administration (SAMHSA). The N-SSATS report: trends in the use of methadone and buprenorphine at substance abuse treatment facilities: 2003 to 2011. Rockville: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2013.
61.
Knudsen HK, Abraham AJ, Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: the importance of funding policies and medical infrastructure. Eval Program Plann. 2011;34(4):375–81.CrossRefPubMedPubMedCentral
Metadata
Title
Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial
Authors
Todd Molfenter
Hannah K. Knudsen
Randy Brown
Nora Jacobson
Julie Horst
Mark Van Etten
Jee-Seon Kim
Eric Haram
Elizabeth Collier
Sanford Starr
Alexander Toy
Lynn Madden
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0665-x

Other articles of this Issue 1/2017

Implementation Science 1/2017 Go to the issue

Research

A comparison of how behavioral health organizations utilize training to prepare for health care reform

Research

Advancing theory development: exploring the leadership–climate relationship as a mechanism of the implementation of cultural competence

Study protocol

Implementation and dissemination of a transition of care program for rural veterans: a controlled before and after study

Research

Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women

Research

Planning to be routine: habit as a mediator of the planning-behaviour relationship in healthcare professionals

Research

Number and type of guideline implementation tools varies by guideline, clinical condition, country of origin, and type of developer organization: content analysis of guidelines