Closing the gaps in opioid use disorder research, policy and practice: conference proceedings

Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

BACKGROUND

Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention.

OBJECTIVE

This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions.

METHODS

The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification.

RESULTS

The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement.

CONCLUSIONS

Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.

Reflections of Healthcare Experiences of African Americans With Sickle Cell Disease or Cancer: A Qualitative Study

BACKGROUND

The experiences of African American adult patients before, during, and after acute care utilization are not well characterized for individuals with sickle cell disease (SCD) or cancer.

OBJECTIVE

To describe the experiences of African Americans with SCD or cancer before, during, and after hospitalization for pain control.

METHODS

We conducted a qualitative study among African American participants with SCD (n = 15; 11 male; mean age, 32.7 ± 10.9 years; mean pain intensity, 7.8 ± 2.6) or cancer (n = 15; 7 male; mean age, 53.7 ± 15.2 years; mean pain intensity, 4.9 ± 3.7). Participants completed demographic questions and pain intensity using PAINReportIt and responded to a 7-item open-ended interview, which was recorded and transcribed verbatim. We used content analysis to identify themes in the participants' responses.

RESULTS

Themes identified included reason for admission, hospital experiences, and discharge expectations. Pain was the primary reason for admission for participants with SCD (n = 15) and for most participants with cancer (n = 10). Participants of both groups indicated that they experienced delayed treatment and a lack of communication. Participants with SCD also reported accusations of drug-seeking behavior, perceived mistreatment, and feeling of not being heard or believed. Participants from both groups verbalized concerns about well-being after discharge and hopeful expectations.

CONCLUSIONS

Race-concordant participants with SCD but not with cancer communicated perceived bias from healthcare providers.

IMPLICATIONS FOR PRACTICE

Practice change interventions are needed to improve patient-provider interactions, reduce implicit bias, and increase mutual trust, as well as facilitate more effective pain control, especially for those who with SCD.

Letting the sun shine on patient voices: Perspectives about medications for opioid use disorder in Florida

The 2017 declaration of the opioid overdose epidemic as a public health emergency in the United States enhanced a national focus on effective and sustainable treatments for opioid use disorder (OUD), including multiple options utilizing medication. Despite clinical studies demonstrating efficacy, numerous reports suggest that medication for opioid use disorder (MOUD) has been underutilized, leaving many questions about specific barriers and facilitators. This study examines factors impacting attitudes and perspectives related to MOUD that influence its utilization and acceptance in a state where support for harm reduction and treatment policy has been limited. With consideration for the contextual cultural factors of this region, we conducted twelve individual interviews with people seeking treatment for OUD at a detoxification facility in Tampa, Florida. This study called attention to the perspectives of patients regarding their unique self-identified needs and beliefs around MOUD as it relates to their addiction treatment. We evaluated the perspectives collected in the interviews (N = 12) based on three main themes: 1) positive perceptions of MOUD; 2) negative perceptions of MOUD; and 3) overall perceptions of treatment and recovery. Findings suggest that participants' varying levels of positive and negative perspectives about MOUD are informed by nuances in their social networks and varying levels of exposure or education. For example, participants held more negative opinions of MOUD than positive, accounting mostly for a view that it serves as a direct substitute for illicit opioids rather than a sustainable or supportive solution addressing the underlying causes of addiction. These opinions may be largely dependent on geographic location that dictates policy, practice, funding, and, in turn, cultural acceptance of MOUD. The findings in this qualitative study may help to inform future education efforts, initiatives addressing patient-level concerns, and provide decision-makers with meaningful information to tailor programmatic policy and procedures specific to local area social inputs and resource exposure.

Assessing the readiness of digital data infrastructure for opioid use disorder research

BACKGROUND

Gaps in electronic health record (EHR) data collection and the paucity of standardized clinical data elements (CDEs) captured from electronic and digital data sources have impeded research efforts aimed at understanding the epidemiology and quality of care for opioid use disorder (OUD). We identified existing CDEs and evaluated their validity and usability, which is required prior to infrastructure implementation within EHRs.

METHODS

We conducted (a) a systematic literature review of publications in Medline, Embase and the Web of Science using a combination of at least one term related to OUD and EHR and (b) an environmental scan of publicly available data systems and dictionaries used in national informatics and quality measurement of policy initiatives. Opioid-related data elements identified within the environmental scan were compared with related data elements contained within nine common health data code systems and each element was graded for alignment with match results categorized as "exact", "partial", or "none."

RESULTS

The literature review identified 5186 articles for title search, of which 75 abstracts were included for review and 38 articles were selected for full-text review. Full-text articles yielded 237 CDEs, only 12 (5.06%) of which were opioid-specific. The environmental scan identified 379 potential data elements and value sets across 9 data systems and libraries, among which only 84 (22%) were opioid-specific. We found substantial variability in the types of clinical data elements with limited overlap and no single data system included CDEs across all major data element types such as substance use disorder, OUD, medication and mental health. Relative to common health data code systems, few data elements had an exact match (< 1%), while 61% had a partial match and 38% had no matches.

CONCLUSIONS

Despite the increasing ubiquity of EHR data standards and national attention placed on the opioid epidemic, we found substantial fragmentation in the design and construction of OUD related CDEs and little OUD specific CDEs in existing data dictionaries, systems and literature. Given the significant gaps in data collection and reporting, future work should leverage existing structured data elements to create standard workflow processes to improve OUD data capture in EHR systems.