Objective 3.4: Develop and test strategies for effectively and sustainably implementing evidence-based treatments
Validated treatment strategies for SUDs have great potential to make a positive impact on public health. The size of this impact, however, is limited by the inconsistent use of evidence-based interventions in real-world settings—the "evidence-to-practice gap." A 2012 NIDA workgroup report outlined deficiencies in delivery of evidence-based treatments in SUD treatment centers, which included lack of medication-assisted treatment, recovery services, mental health assessments, and testing for infectious diseases (HIV, hepatitis C, etc.), as well as lack of fidelity to evidence-based practices in delivery of psychosocial interventions, among others.109
Research is needed to identify specific barriers to and facilitators of implementation and to explore approaches to support sustainable implementation of evidence-based practices—for example, research that addresses how various business practices, workforce strategies (e.g., health educators, peer support, etc.), service delivery models, coordinated care models, and screening and referral processes can improve treatment delivery and patient retention and outcomes. Targeted research is also needed to develop implementation strategies that address delivery-system-specific needs, including those of the criminal justice system, primary care, and integrated treatment systems. To address this need, NIDA will support research to develop and test strategies for effectively and sustainably implementing evidence-based treatments for SUDs in diverse health care delivery settings.
- Identify the factors that influence effective and sustainable dissemination and implementation of evidence-based practices for treatment of SUDs and common comorbidities
- Develop and validate novel implementation strategies for delivering evidence-based SUD treatment and integrated treatment services in diverse health care settings
- Develop and test innovative approaches to leverage technology to support implementation of evidence-based practices
Improving Treatment with Electronic Health Record Technology
About 10 percent of people in need of treatment for an SUD receive specialty treatment.1 Of those who are treated for an opioid use disorder, less than 30 percent receive medication-assisted treatments (MAT)—buprenorphine, methadone, or extended-release naltrexone (Vivitrol®)—even though there is strong evidence they are effective.110 The two major questions in the addiction treatment field are:
- How can we get more people with opioid use disorders to engage in treatment?
- How can we make sure the treatment they receive is based on the best available science?
The growing adoption of electronic health records (EHRs) provides an important tool to address this problem.
People with SUDs are often seen by clinicians (i.e., their primary care doctor) in general medical settings, but visits typically focus on managing other illnesses. Substance use is rarely discussed or addressed in such visits. The NIDA Center for Clinical Trials Network, in consultation with the Office of the National Coordinator for Health IT, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration, is developing a Clinical Decision Support (CDS) tool that can be incorporated into EHRs to help primary care providers identify patients with opioid use disorders and determine the best treatments for them. The CDS will include guidance on how to screen for and assess SUDs and will help the health care provider develop a plan of action tailored to meet the needs of the patient, taking into consideration the patient’s motivation and treatment preferences and any co-occurring health conditions.
This effort will encourage the general health care system to identify patients in need of treatment, promote the use of evidence-based treatments like MAT, and foster the collection of standardized clinical data related to substance use in EHRs.