RACHAEL KENNEY
Health Science Specialist, Veterans Health Administration

The number of Veterans (Vets) that the Veterans Health Administration (VA) treated for Opioid Use Disorder (OUD) nearly tripled from 25,000 in 2003 to over 69,000 in 2017. In 2019, the Consortium to Disseminate and Understand Implementation of OUD Treatment (CONDUIT) formed to address this challenge. CONDUIT is a compilation of seven projects focused on increasing treatment for OUD in various settings. One aspect of CONDUIT is an Opioid Addiction and Recovery Veteran Engagement Board (OAR-VEB). The board will meet in person for a kick-off (planned for Spring 2020) and then meet monthly by phone. On each one-hour call, investigators from a project will present a challenge to troubleshoot. This Pragmatic Methods and Evaluation abstract describes the development of this board.

The Denver Veteran Engagement Core (VEC) is selecting OAR-VEB members from each CONDUIT site (Table 1). Members are Vets who identify as being “in recovery” from OUD.

The VEC utilized tools from the VA and the Health Care Systems Research Network to guide board development. The VEC created tools, conducted outreach in Denver, and assisted local contacts at the remaining CONDUIT sites with their outreach. Local contacts performed local outreach and screened Vets before providing contact information to the VEC. Outreach was conducted at VA (e.g., substance use clinics) and non-VA (e.g., Vet-Centers) entities.

To date, 22 interested Vets were identified. Three interested Vets were not in recovery from OUD, two withdrew, one was not affiliated with a CONDUIT site, and one was unreachable. The remaining 15 were interviewed. None withdrew their interest after the interview. To date, 15 Vets have been interviewed and eight members from four sites have agreed to participate. (Table 1)

Identifying local outreach contacts was key; this allowed the VEC to focus on candidates who met the membership criteria. Advertisements, email blasts, and reaching out to outside organizations did not yield a high response.

NICOLE WAGNER
PhD, Kaiser Permanente Colorado Institute for Health Research

Uptake of a new health intervention is dependent on patient acceptance and responsiveness. 1) Patient report is frequently used to assess patient responsiveness due to the low cost and limited labor requirements. 2) However, patient report is prone to errors, such as over-reporting and missing data. 2), 3) Incorporating measures of patient responsiveness from multiple sources presents an opportunity to sustain the low cost and labor requirements while increasing data accuracy and comprehensiveness. Measures from multiple sources may also provide an opportunity to identify strategies for adaptation. 4) To assess the value of a mixed methods approach, this study describes the use of electronic health record (EHR) data, patient report, and implementor logs for measuring patient responsiveness in a pragmatic intervention trial.

Just in Case (JIC) was a cluster randomized intervention trial, designed to increase the uptake of naloxone, an overdose antagonist medication, in patients on chronic opioid therapy. JIC was conducted between 2017 and 2019 at Denver Health Medical Center, a safety net health system serving the Denver metro area. Patients 18 years and older filling chronic opioid medications were eligible to receive naloxone co-dispensing. Eligible patients were recruited to complete surveys at baseline, 4 months, and 8 months (patient report). Pharmacy staff in the intervention arm recorded naloxone co-dispensing events and reasons for nonacceptance in a pharmacy fidelity log (implementor log).

Patient responsiveness measures included naloxone uptake and barriers to naloxone uptake. Naloxone uptake was captured in the EHR using naloxone dispensing data. Reasons for not accepting naloxone were coded for common themes in patient report surveys and implementor log.

Using EHR pharmacy records, 527 eligible patients were identified with 204 naloxone fills. Barriers to naloxone uptake from patient report included lack of knowledge on naloxone (40%), not thinking they needed it (88%), and fear of repercussions from pharmacists or doctors (20%). Barriers to naloxone uptake from implementors included patients already had naloxone (36%) and weren’t willing to pay for naloxone (28%).

A mixed methods approach using measures from the EHR, patients, and implementors provides a comprehensive assessment of patient responsiveness with increased accuracy. Each measure contributed unique data to inform potential opportunities for improvement and adaptation. EHR data contributed accurate counts of acceptance. Patient report identified a knowledge gap indicating a more robust education program may be needed. Implementors reported cost issues indicating a potential protocol modification could improve uptake.