Impacts: The proposed research addresses a critical VHA and HSR&D priority to improve access to opioid use disorder (OUD) treatment by developing and pilot testing a novel telehealth treatment delivery intervention. Background: With the national opioid epidemic, OUD prevalence in Veterans has increased and many Veterans with OUD experience serious and preventable harms including overdose and suicide. Increasing access to treatment, especially with the medication buprenorphine, can help prevent these harms. However, only a third of Veterans with OUD receive evidence-based treatment. The biggest access barrier is lack of trained buprenorphine providers on-site across VHA facilities, contributing to particularly low treatment for Veterans receiving care in Community-Based Outpatient Clinics (CBOCs). Telehealth interventions have been developed in the VA to allow specialists in VA Medical Centers to deliver treatment to Veterans in CBOCs, but minimal research has been done on telehealth for substance use disorders. A few VA facilities, including the VA Ann Arbor Healthcare System have begun to use telehealth to deliver OUD treatment, but research is needed to inform a telehealth model that can be scalable across facilities, examine impact on treatment use, and determine where telehealth should be targeted to maximize impact. The methods and sequence have been designed to address these pressing questions in the following 3 aims:
Aim 1 : Semi-structured interviews will be conducted with patients and clinicians in four facilities, including the VA Ann Arbor Healthcare System, that have begun to use telehealth delivery of OUD treatment to Veterans in CBOCs, to understand components of their interventions, perceptions of treatment and barriers and facilitators to use. Informed by these qualitative findings, a Delphi panel of OUD experts, including frontline providers, will help refine a telehealth intervention that can be feasible across facilities and will be pilot tested in Aim 2.
Aim 2 : In a pilot trial, CBOC Veterans with OUD will be randomized to the telehealth OUD intervention refined in Aim 1 (n=20) or in-person OUD treatment as usual (n=20). The study will examine feasibility and acceptability incorporating survey data and qualitative interviews with participants and study clinicians and characterize treatment engagement, retention and substance-use outcomes over 3 month followup.
Aim 3 : Using national VHA data of CBOC Veterans with OUD, analyses will examine factors associated with patient and facility-level variation in OUD treatment to understand areas where treatment is need. Analyses will also examine facility level variation in buprenorphine provider capacity and telehealth use. These findings will identify key patient and facility-level factors associated with treatment need and indicate which patients and CBOCs should be prioritized for telehealth. Candidate: The PI's long-term goal is to build on her addiction clinical and research background to become a leading VA health services researcher developing and evaluating interventions to improve treatment and outcomes for Veterans with OUD and other substance use disorders. The PI will gain training in: 1) mixed methods, 2) randomized intervention trials, 3) implementation science and 4) multi-level modeling. With a stellar mentorship team and key operational partners, the research and training in this CDA will allow her to launch a long trajectory of research developing and evaluating effective and accessible interventions to improve outcomes for Veterans with OUD and other substance use disorders.
Improving treatment access for Veterans with opioid use disorder (OUD) is a top VHA priority. With the national opioid crisis, many Veterans are suffering from OUD, which is associated with overdose, suicide and numerous other serious harms. Less than a third of Veterans with OUD receive evidence based pharmacotherapy treatment. Delivering treatment has been a major challenge due to a lack of trained providers in many VA facilities, particularly in community-based outpatient clinics (CBOCs). The current proposal will capitalize on the telehealth infrastructure in the VA to increase OUD treatment access by refining and then pilot testing a telehealth intervention delivering OUD treatment to Veterans in CBOCs and examine the VA OUD treatment landscape to understand where to best prioritize telehealth implementation. This research will inform the development of a telehealth intervention for OUD that can be implemented in the VHA and will inform future telehealth interventions to improve treatment for the large population of Veterans with substance use disorders.
