Despite the availability of effective pharmacological interventions for opioid use disorder, less than 24% of individuals receive any medication for their opioid addiction.
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However, uptake of this model has been slow, with less than 5% of physicians becoming waivered by 2014.
This study assessed enrollment of community health centers (CHCs) in the Office-based Buprenorphine Opioid Treatment Collaborative Care Model (STATE OBOT-B) program beginning in 2007.
Community health centers (CHCs) were required to complete patient reporting forms at three time points: enrollment, quarterly during enrollment in the program, and at disenrollment (i.e., discharge). CHCs also provided weekly reports with program-related data. This descriptive study includes information on the number of CHCs enrolled, number of physicians participating at CHCs, annual active admissions, and duration of treatment between August 2007 and December 2013.
Nineteen Community health centers (CHCs) enrolled in the STATE OBOT-B program between 2007 and 2013. Of the 19 enrollees, five returned the grant contract within the first 3-16 months because they were unable to use funds sufficiently and meet caseload requirements for reasons such as lack of administrative support and difficulty recruiting NCMs. Among the 14 remaining CHCs, annual admissions increased from 178 to 1210 over this timeframe. Half of these sites hired additional NCMs (the grant only required and funded one full-time NCM) to increase their capacity to treat more patients.
Before the initiation of the STATE OBOT-B program, 24 physicians were waivered. This number increased to 114 by 2010. By 2013, two thirds of enrolled patients remained in treatment for more than 12 months. Patients were largely white (73%), male (63%), between ages 21 to 39, and unemployed (66%). Almost 90% of NCMs “strongly agreed” on a 5-point Likert scale that the training sessions were helpful.
This study provides information on implementation and utilization of an office-based buprenorphine care delivery model. The authors used the ADAPTS implementation science model which included defining steps for assessment, deliverables, and sustainability to explain the implementation of the STATE OBOT-B program.
This descriptive study highlights the need to think critically about barriers to adopting effective interventions, addressing those barriers, measuring and evaluating programs to do so, and considering how to maintain/sustain programs over time given limitations (e.g., reimbursement and funding). The promising initial results from this study suggest that this model may be worth evaluating further and potentially implementing elsewhere.
Medication-assisted treatment exists in several forms, but is of no use to a patient who cannot access it.
By incorporating this model into Community health centers (CHCs), marginalized individuals such as the homeless and uninsured can initiate treatments they otherwise would be unable to access.
Of note: This model also relies on Nurse Care Managers to act as the primary point of contact for patients and liaison between the patient and their physician. Since Nurse Care Managers carry out multiple steps in the care cascade, more patients can access treatment since they do not need to meet with physicians at every visit.
This model for office-based buprenorphine delivery relies heavily on Nurse Care Managers for many components of care. This study shows that it is feasible to hire Nurse Care Managers to handle high patient caseloads so access to treatment is not limited by the number of prescribing physicians on staff. With the aid of a medical assistant, Nurse Care Managers in this program were managing 125+ patients.
More research is needed to evaluate the effectiveness of this model in Massachusetts and to determine if this approach can be implemented in other states.
LaBelle, C. T., Han, S. C., Bergeron, A., & Samet, J. H. (2015). Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. doi:10.1016/j.jsat.2015.06.010
l
However, uptake of this model has been slow, with less than 5% of physicians becoming waivered by 2014.
This study assessed enrollment of community health centers (CHCs) in the Office-based Buprenorphine Opioid Treatment Collaborative Care Model (STATE OBOT-B) program beginning in 2007.
Community health centers (CHCs) were required to complete patient reporting forms at three time points: enrollment, quarterly during enrollment in the program, and at disenrollment (i.e., discharge). CHCs also provided weekly reports with program-related data. This descriptive study includes information on the number of CHCs enrolled, number of physicians participating at CHCs, annual active admissions, and duration of treatment between August 2007 and December 2013.
Nineteen Community health centers (CHCs) enrolled in the STATE OBOT-B program between 2007 and 2013. Of the 19 enrollees, five returned the grant contract within the first 3-16 months because they were unable to use funds sufficiently and meet caseload requirements for reasons such as lack of administrative support and difficulty recruiting NCMs. Among the 14 remaining CHCs, annual admissions increased from 178 to 1210 over this timeframe. Half of these sites hired additional NCMs (the grant only required and funded one full-time NCM) to increase their capacity to treat more patients.
Before the initiation of the STATE OBOT-B program, 24 physicians were waivered. This number increased to 114 by 2010. By 2013, two thirds of enrolled patients remained in treatment for more than 12 months. Patients were largely white (73%), male (63%), between ages 21 to 39, and unemployed (66%). Almost 90% of NCMs “strongly agreed” on a 5-point Likert scale that the training sessions were helpful.
This study provides information on implementation and utilization of an office-based buprenorphine care delivery model. The authors used the ADAPTS implementation science model which included defining steps for assessment, deliverables, and sustainability to explain the implementation of the STATE OBOT-B program.
This descriptive study highlights the need to think critically about barriers to adopting effective interventions, addressing those barriers, measuring and evaluating programs to do so, and considering how to maintain/sustain programs over time given limitations (e.g., reimbursement and funding). The promising initial results from this study suggest that this model may be worth evaluating further and potentially implementing elsewhere.
Medication-assisted treatment exists in several forms, but is of no use to a patient who cannot access it.
By incorporating this model into Community health centers (CHCs), marginalized individuals such as the homeless and uninsured can initiate treatments they otherwise would be unable to access.
Of note: This model also relies on Nurse Care Managers to act as the primary point of contact for patients and liaison between the patient and their physician. Since Nurse Care Managers carry out multiple steps in the care cascade, more patients can access treatment since they do not need to meet with physicians at every visit.
This model for office-based buprenorphine delivery relies heavily on Nurse Care Managers for many components of care. This study shows that it is feasible to hire Nurse Care Managers to handle high patient caseloads so access to treatment is not limited by the number of prescribing physicians on staff. With the aid of a medical assistant, Nurse Care Managers in this program were managing 125+ patients.
More research is needed to evaluate the effectiveness of this model in Massachusetts and to determine if this approach can be implemented in other states.
LaBelle, C. T., Han, S. C., Bergeron, A., & Samet, J. H. (2015). Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. doi:10.1016/j.jsat.2015.06.010
l
However, uptake of this model has been slow, with less than 5% of physicians becoming waivered by 2014.
This study assessed enrollment of community health centers (CHCs) in the Office-based Buprenorphine Opioid Treatment Collaborative Care Model (STATE OBOT-B) program beginning in 2007.
Community health centers (CHCs) were required to complete patient reporting forms at three time points: enrollment, quarterly during enrollment in the program, and at disenrollment (i.e., discharge). CHCs also provided weekly reports with program-related data. This descriptive study includes information on the number of CHCs enrolled, number of physicians participating at CHCs, annual active admissions, and duration of treatment between August 2007 and December 2013.
Nineteen Community health centers (CHCs) enrolled in the STATE OBOT-B program between 2007 and 2013. Of the 19 enrollees, five returned the grant contract within the first 3-16 months because they were unable to use funds sufficiently and meet caseload requirements for reasons such as lack of administrative support and difficulty recruiting NCMs. Among the 14 remaining CHCs, annual admissions increased from 178 to 1210 over this timeframe. Half of these sites hired additional NCMs (the grant only required and funded one full-time NCM) to increase their capacity to treat more patients.
Before the initiation of the STATE OBOT-B program, 24 physicians were waivered. This number increased to 114 by 2010. By 2013, two thirds of enrolled patients remained in treatment for more than 12 months. Patients were largely white (73%), male (63%), between ages 21 to 39, and unemployed (66%). Almost 90% of NCMs “strongly agreed” on a 5-point Likert scale that the training sessions were helpful.
This study provides information on implementation and utilization of an office-based buprenorphine care delivery model. The authors used the ADAPTS implementation science model which included defining steps for assessment, deliverables, and sustainability to explain the implementation of the STATE OBOT-B program.
This descriptive study highlights the need to think critically about barriers to adopting effective interventions, addressing those barriers, measuring and evaluating programs to do so, and considering how to maintain/sustain programs over time given limitations (e.g., reimbursement and funding). The promising initial results from this study suggest that this model may be worth evaluating further and potentially implementing elsewhere.
Medication-assisted treatment exists in several forms, but is of no use to a patient who cannot access it.
By incorporating this model into Community health centers (CHCs), marginalized individuals such as the homeless and uninsured can initiate treatments they otherwise would be unable to access.
Of note: This model also relies on Nurse Care Managers to act as the primary point of contact for patients and liaison between the patient and their physician. Since Nurse Care Managers carry out multiple steps in the care cascade, more patients can access treatment since they do not need to meet with physicians at every visit.
This model for office-based buprenorphine delivery relies heavily on Nurse Care Managers for many components of care. This study shows that it is feasible to hire Nurse Care Managers to handle high patient caseloads so access to treatment is not limited by the number of prescribing physicians on staff. With the aid of a medical assistant, Nurse Care Managers in this program were managing 125+ patients.
More research is needed to evaluate the effectiveness of this model in Massachusetts and to determine if this approach can be implemented in other states.
LaBelle, C. T., Han, S. C., Bergeron, A., & Samet, J. H. (2015). Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. J Subst Abuse Treat. doi:10.1016/j.jsat.2015.06.010
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