Opioid Use Disorder Clinical Trial
Official title:
Making Medication Assisted Treatment Available to Veterans With Opioid Use Disorders at CBOCs Using Telemedicine (PII 18-178)
Verified date | March 2020 |
Source | VA Office of Research and Development |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Medication Assisted Treatment (MAT) of Veterans with Opioid Use Disorder (OUD) decreases
mortality and improves treatment follow-up. However, outside of large and/or urban VA medical
centers, there are shortages of providers with experience treating OUD and a license to
prescribe buprenorphine. This has resulted in decreased access to MAT (buprenorphine/naloxone
and injectable naltrexone) at rural CBOCs and increased overdose rates in rural areas. Some
individual prescribers have used clinical video teleconferencing (CVT) to overcome geographic
barriers and prescribe MAT to Veterans in CBOCs. However, while locally effective, these
arrangements are not standardized and are not parts of larger VISN-wide or national VHA
strategies.
This proposal describes an effective program that the investigators propose to replicate and
expand. The program involves increasing prescribing rates of MAT for OUD in CBOCs using
telemedicine. The investigators propose to (A) develop materials and procedures for the
dissemination of telemedicine delivery of MAT to Veterans at CBOCs and (B) implement
telemedicine prescribing of MAT at rural CBOCs in Northern Maine that lack on-site MAT
providers. MAT will be prescribed by the VISN 1 Telemental Health Hub, which already provides
medication management, psychotherapy, and some MAT to sites in Northern Maine.
In later years, the program will be expanded to other VISN 1 CBOCs, and to other TMH Regional
Hubs that provide services to wide catchment areas in other VISNs. By building on an existing
infrastructure connecting these TMH Regional Hubs to CBOCs and collaborating with other
national initiatives (e.g. SCAN ECHO, PDSI, and academic detailing), telemedicine MAT will be
rapidly disseminated to Veterans at CBOCs who are at high risk for illness, overdose, and
premature death from opioids.
Status | Completed |
Enrollment | 12 |
Est. completion date | March 31, 2019 |
Est. primary completion date | March 31, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A and older |
Eligibility |
Inclusion Criteria: - Veterans with OUD Exclusion Criteria: - n/a |
Country | Name | City | State |
---|---|---|---|
United States | VA Maine Healthcare System | Augusta | Maine |
United States | VA Connecticut Healthcare System West Haven Campus, West Haven, CT | West Haven | Connecticut |
Lead Sponsor | Collaborator |
---|---|
VA Office of Research and Development |
United States,
Brunet N, Moore DT, Lendvai Wischik D, Mattocks KM, Rosen MI. Increasing buprenorphine access for veterans with opioid use disorder in rural clinics using telemedicine. Subst Abus. 2020 Feb 20:1-8. doi: 10.1080/08897077.2020.1728466. [Epub ahead of print] — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Population potentially able to benefit from telemedicine MAT | Review Veterans with OUD at CBOC and compare those referred to telemedicine MAT to those not referred. Note that OUD diagnosis may increase over time with better OUD detection |
through study completion, up to 1 year | |
Primary | AUDIT-C | The Alcohol Use Disorders Identification Test is a ten-question test developed by a World Health Organization-sponsored collaborative project to determine if a person may be at risk for alcohol abuse problems. | through study completion, up to 1 year | |
Primary | Cost of Telemedicine MAT | cost of time provider and other staff spent in service delivery preparing for and interacting with patients (prompted by CPT-coded encounters). Costs are calculated by multiplying time by personnel costs. | through study completion, up to 1 year | |
Primary | Cost of Training and Implementation | cost of time spent by External and Internal facilitators on training/implementation. Time-spent will be assessed by weekly questions about a list of possible training activities. | through study completion, up to 1 year | |
Primary | Veterans' subjective experience of telemedicine MAT | Interviews with treated Veterans covering the following topics (9): how came to program, other options considered; experience of intake, of induction onto MAT, of maintenance tele-prescribing visits, of other addiction treatment; good things/not-so-good things about treatment, recommended improvements, how compares to in-person treatment. | through study completion, up to 1 year | |
Primary | Providers' experience of implementing MAT | Key informant interviews after implementation with hub and spoke providers, as described earlier. | through study completion, up to 1 year | |
Primary | Negative toxicology tests | % toxicology tests that are negative for illicit opioids | through study completion, up to 1 year | |
Primary | Number of CBOCs participating in telemedicine MAT | Number of CBOCs utilizing telemedicine MAT | through study completion, up to 1 year | |
Primary | Brief Addiction Monitor-Revised (BAM-R) | Brief Addiction Monitor-Revised (BAM-R) upon intake and two months later. | through study completion, up to 1 year | |
Primary | Number of providers participating in telemedicine MAT | Number at hubs and proportions tele-prescribing MAT; number at spokes seeing Veterans as part of their MAT treatment. | through study completion, up to 1 year |
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