Implementing Evidence-based Practices to Address SUD

Implementing Evidence-based Practices to Address SUD

Challenge

The opioid and other substance use crises remain one of the nation’s most pressing public health challenges. Despite the recognized efficacy of pharmacotherapy, the challenge of implementing evidence-based practice (EBP) persists, with several barriers hindering the successful implementation of medications for opioid use disorder (OUD) and alcohol use disorder (AUD). Combatting the substance use disorder (SUD) crisis requires effective approaches that employ a comprehensive strategy for implementing EBPs that work in conjunction with behavioral therapies.

Solution

States play a pivotal role as public policy champions in shaping and advancing transformative healthcare practices, such as the broad use of pharmacotherapies for SUDs. Hospital emergency departments (EDs) can further serve as a critical access point for individuals to start treatment for SUD.

The State of Vermont has become a trendsetter in treating OUDs by developing the Hub-and-Spoke (H&S) model of SUD treatment. Building on this foundation, Vermont introduced the Rapid Access to Medication (RAM) for OUD initiative and the subsequent Rapid Treatment Access (RTA) for AUD initiative to improve the responsiveness of the treatment system for individuals seeking SUD treatment.

Both initiatives leveraged team-based and individual learning collaborative sessions using change strategy tools, such as NIATx coaching, the walk-through, and the Plan-Do-Study-Act (PDSA) cycles. Vermont’s implementation approach’s core components involved selecting a relevant aim, assembling dedicated teams, pilot testing, providing individual and group coaching to practitioners, and emphasizing continuous improvement.

The Time-to-Treatment Tracking Tool (T5) and Incentive Payment Opportunity (IPO) provided financial incentives for providers who accomplished items on a checklist within three days of treatment initiation, ranging from conducting community provider sessions to providing rapid treatment access. The T5 helped identify both real and perceived barriers to treatment access and pinpoint gaps in service provision.

Outcomes

In the RAM project, 13 out of 14 Vermont-based hospital EDs established protocols for starting individuals with OUD on MOUD, along with a warm handoff to a designated outpatient treatment provider for continuation after discharge. These individuals are also offered support from a recovery coach in the ED. In the RTA program, 92% of respondents engaged in improving access to AUD treatment, and 100% of respondents supported using medication to manage alcohol withdrawal.

The innovative approach used to refine and improve Vermont’s substance use treatment landscape has brought about transformative change in addressing OUD and AUD. The RAM and RTA initiatives are creating a paradigm shift in the provision of treatment, with the State taking the lead in promoting a timeliness standard for MOUD and AUD service initiation. These initiatives recognize and reward an integrated community-based treatment system responsive to individuals seeking treatment. They further support hospital EDs in starting individuals on medications to treat OUD and AUD during an ED stay and facilitating access to continued medication after discharge.

Vermont is well-positioned to proceed with the RAM and RTA initiatives. Of equal importance, these initiatives present a replicable framework for spreading and scaling up EBPs in other states to address three clear aims:

Initiate treatment for OUD or AUD, including medications, within three days of initial contact.
Eliminate barriers to access.
Ensure continuation of care.