Strategies for Substance Use Disorder
(STUN II Trial)
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Ohio State University
Disqualifiers: Ongoing conflicting programs
No Placebo Group
Trial Summary
What is the purpose of this trial?The STop UNhealthy (STUN) Substance Use Now Trial (STUN II) is a multisite trial aiming to evaluate the comparative effectiveness of the following strategies for improving the implementation of screening and interventions for substance use disorders in primary care: practice facilitation (PF), PF plus a learning collaborative (LC), PF plus performance incentives (PI), and PF+LC+PI. We plan to enroll 144 clinic staff participants from 48 primary care practices
Will I have to stop taking my current medications?
The trial information does not specify whether participants must stop taking their current medications.
What data supports the effectiveness of this treatment for substance use disorder?
The Massachusetts Collaborative Care Model, which involves a team approach with nurses and doctors, has been effective in expanding treatment for opioid use disorders in community health centers. This model increased the number of doctors able to prescribe buprenorphine by 375% and significantly boosted patient admissions, showing promise for similar collaborative care strategies in treating substance use disorders.
12345Is the treatment strategy for substance use disorder safe for humans?
The research articles reviewed do not provide specific safety data for the treatment strategies mentioned, such as Learning Collaborative or Community-Engaged Multisector Collaborative Care Model, in humans.
13467How is the Strategies for Substance Use Disorder treatment different from other treatments?
This treatment is unique because it combines a collaborative care model with performance incentives and practice facilitation, focusing on teamwork among healthcare providers to improve care for substance use disorders. It emphasizes coordination between mental health and substance use services, which is often lacking in traditional treatments.
34589Eligibility Criteria
This trial is for staff at primary care practices who are involved in screening and interventions for substance use disorders. It's not specified who can't join, but typically those with conflicts of interest or inability to participate fully might be excluded.Inclusion Criteria
Clinic staff members from primary care practices who provide care for adult patients and have a leadership role within the practice (e.g. lead physician, practice manager, lead medical assistant/nurse, clinical champion)
Exclusion Criteria
Clinic staff members who already have ongoing involvement in programs that would conflict with or preclude this study
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Implementation
Implementation of evidence-based screening and interventions for substance use disorders using various strategies
12 months
Monthly virtual sessions and practice facilitation
Follow-up
Participants are monitored for the effectiveness of the implementation strategies
12 months
Participant Groups
The STUN II Trial is testing four strategies to improve handling of substance use disorders in primary care: practice facilitation (PF), PF with a learning collaborative (LC), PF with performance incentives (PI), and the combination of all three methods.
4Treatment groups
Experimental Treatment
Active Control
Group I: Practice Facilitation + Performance IncentivesExperimental Treatment2 Interventions
Practice Facilitation: Practices will receive up to 2 hours of direct practice facilitation services per month for 12 months.
Performance Incentives: Practices will receive a maximum total of $6,000 based on their performance during the 12-month implementation period. They will have the opportunity to receive up to $1,500 per quarter if they reach performance milestones for the quarter.
Group II: Practice Facilitation + Learning Collaborative + Performance IncentivesExperimental Treatment3 Interventions
Practice Facilitation: Practices will receive up to 2 hours of direct practice facilitation services per month for 12 months.
Learning Collaborative (LC): Virtual LC sessions will be held monthly and will include participants presenting anonymized cases to clinical experts, targeted brief didactics related to the content of the cases, and time for open discussion and Q\&A.
Performance Incentives: Practices will receive a maximum total of $6,000 based on their performance during the 12-month implementation period. They will have the opportunity to receive up to $1,500 per quarter if they reach performance milestones for the quarter.
Group III: Practice Facilitation + Learning CollaborativeExperimental Treatment2 Interventions
Practice Facilitation (PF): Practices will receive up to 2 hours of direct practice facilitation services per month for 12 months.
Learning Collaborative (LC): Virtual LC sessions will be held monthly and will include participants presenting anonymized cases to clinical experts, targeted brief didactics related to the content of the cases, and time for open discussion and Q\&A.
Group IV: Practice Facilitation OnlyActive Control1 Intervention
Practice Facilitation: Practices will receive up to 2 hours of direct practice facilitation services per month for 12 months.
Learning Collaborative is already approved in United States for the following indications:
🇺🇸 Approved in United States as Learning Collaborative for:
- Depression
- Anxiety
- Stress-related Problems
- Mental Health Wellness
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Bon Secours Mercy HealthCincinnati, OH
Ohio Association of Community Health CentersColumbus, OH
The Ohio State University Wexner Medical CenterColumbus, OH
Loading ...
Who Is Running the Clinical Trial?
Ohio State UniversityLead Sponsor
Ohio Association of Community Health Centers (OACHC)Collaborator
Agency for Healthcare Research and Quality (AHRQ)Collaborator
Bon Secours Mercy Health (BSMH)Collaborator
References
Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state. [2022]To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM).
Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders. [2023]Rapidly escalating rates of heroin and prescription opioid use have been widely observed in rural areas across the United States. Although US Food and Drug Administration-approved medications for opioid use disorders exist, they are not routinely accessible to patients. One medication, buprenorphine, can be prescribed by waivered physicians in office-based practice settings, but practice patterns vary widely. This study explored the use of a learning collaborative method to improve the provision of buprenorphine in the state of Vermont.
Interagency collaboration in services for people with co-occurring mental illness and substance use disorder. [2006]Historically the divisions between the mental health and substance abuse fields have been so deep that attempts to provide coordinated treatment across service sectors for people with dual diagnoses of psychiatric disorder and substance use disorder have failed. The authors describe a program in Maine designed to develop collaboratives, or communities of providers, who work together to offer coordinated mental health and substance abuse treatment and support. Surveys of provider agencies in one collaborative conducted one year and two years after the collaborative was established showed an increase in interagency referrals, joint assessments of clients, and jointly sponsored training and client services.
Nudging primary care providers to expand the opioid use disorder workforce. [2023]To examine the responsiveness of primary care providers to pro-social and financial incentives to participate in a learning collaborative for the treatment of opioid use disorder (OUD).
Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. [2018]We describe a Massachusetts Bureau of Substance Abuse Services' (BSAS) initiative to disseminate the office-based opioid treatment with buprenorphine (OBOT-B) Massachusetts Model from its development at Boston Medical Center (BMC) to its implementation at fourteen community health centers (CHCs) beginning in 2007. The Massachusetts Collaborative Care Model for the delivery of opioid agonist therapy with buprenorphine, in which nurses working with physicians play a central role in the evaluation and monitoring of patients, holds promise for the effective expansion of treatment for opioid use disorders. The training of and technical assistance for the OBOT nurses as well as a limited program assessment are described. Data spanning 6years (2007-2013) report patient demographics, prior treatment for opioid use disorders, history of overdose, housing, and employment. The expansion of OBOT to the fourteen CHCs increased the number of physicians who were "waivered" (i.e., enabling their prescribing of buprenorphine) by 375%, from 24 to 114, within 3years. During this period the annual admissions of OBOT patients to CHCs markedly increased. Dissemination of the Massachusetts Model of the Office-Based Opioid Treatment with Buprenorphine employing a collaborative care model with a central role for nursing enabled implementation of effective treatment for patients with an opioid use disorder at community health centers throughout Massachusetts while effectively engaging primary care physicians in this endeavor.
A collaborative approach to identifying effective incentives for mental health clinicians to improve depression care in a large managed behavioral healthcare organization. [2021]This descriptive study used stakeholder input to prioritize evidence-based strategies for improving depression care and to select incentives for mental health clinicians to adopt those strategies, and to conduct a feasibility test of an incentive-based program in a managed behavioral healthcare organization (MBHO). In two rounds of interviews and a stakeholder meeting, MBHO administrators and clinicians selected increasing combination treatment (antidepressant plus psychotherapy) rates as the program goal; and paying a bonus for case reviews, clinician feedback, and clinician education as incentives. We assessed program feasibility with case review and clinician surveys from a large independent practice association that contracts with the MBHO. Findings suggest that providing incentives for mental health clinicians is feasible and the incentive program did increase awareness. However, adoption may be challenging because of administrative barriers and limited clinical data available to MBHOs.
Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State. [2018]Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies' own baselines. Weekly feedback was e-mailed to agencies in the alert or alert plus incentives arms. Difference-in difference regressions controlling for client and agency characteristics showed that none of the interventions significantly affected client engagement after outpatient admissions, overall or for sub-groups based on race/ethnicity, age, rural residence, or agency baseline performance. Treatment agencies offered insights related to several themes: delivery system context (e.g., agency time and resources needed during transition to a managed behavioral healthcare system), implementation (e.g., data lag), agency issues (e.g., staff turnover), and client factors (e.g., motivation). Interventions took place during a time of Medicaid expansion and planning for statewide integration of mental health and substance use disorder treatment into a managed care model, which may have resulted in agencies not responding to the interventions. Moreover, incentives and alerts at the agency-level may not be effective when factors are at play beyond the agency's control.
Improving Coordination of Addiction Health Services Organizations with Mental Health and Public Health Services. [2018]In this mixed-method study, we examined coordination of mental health and public health services in addiction health services (AHS) in low-income racial and ethnic minority communities in 2011 and 2013. Data from surveys and semistructured interviews were used to evaluate the extent to which environmental and organizational characteristics influenced the likelihood of high coordination with mental health and public health providers among outpatient AHS programs. Coordination was defined and measured as the frequency of interorganizational contact among AHS programs and mental health and public health providers. The analytic sample consisted of 112 programs at time 1 (T1) and 122 programs at time 2 (T2), with 61 programs included in both periods of data collection. Forty-three percent of AHS programs reported high frequency of coordination with mental health providers at T1 compared to 66% at T2. Thirty-one percent of programs reported high frequency of coordination with public health services at T1 compared with 54% at T2. Programs with culturally responsive resources and community linkages were more likely to report high coordination with both services. Qualitative analysis highlighted the role of leadership in leveraging funding and developing creative solutions to deliver coordinated care. Overall, our findings suggest that AHS program funding, leadership, and cultural competence may be important drivers of program capacity to improve coordination with health service providers to serve minorities in an era of health care reform.
Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders. [2022]Opioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders.