Medication assisted treatment performance measure development:
Conceptualization and scope of measure
The Washington Circle work group on medication assisted treatment is developing a performance measure to be applied in treatment settings, which includes the following features:
- Measure of process of care
- Applies to adult patients
- A combined measure for opioid and alcohol dependence, with ability to report and analyze separately, separate denominator
- Exclude methadone (measures developed elsewhere)
- Initiation and duration measure
- Useful for primary and specialty settings
- Counseling considered with measure where data permit
- Measure prescribing (it is not possible to measure whether a medication is offered)
- Electronic health record and database-friendly
Operationalizing a measure
The following figure illustrates the relationship between medication treatment and office visits and illustrates one major challenge in operationalizing measures to be applied to a database. It is critical to have both diagnostic and medication treatment information available and consider the intersection between them. Feasibility testing of draft measures is presently being conducted in partnership with Medstat in order to inform optimal specification of a measure. Preliminary findings indicate that the prevalence of medication treatment is low, and diagnosis is important to consider, especially in the case of buprenorphine, which may be used for pain management as well as addiction treatment. Feasibility testing will also examine episodes of treatment to assess persistence of treatment.
Schedule for measure development
At the end of October 2007, we will complete work on specifying a medication assisted treatment measure, and requirements for pilot testing. Pilot testing of a specified measure is anticipated for the year 2008.
References
Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.
Center for Substance Abuse Treatment. Naltrexone and Alcohol Treatment. Treatment Improvement Protocol (TIP) Series 28. DHHS Publication No. (SMA)02-XXXX. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2002.
Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.
Chick J, Gough K, Falkowski W, Kershaw P, Hore B, Mehta B, Ritson B, Ropner R, Torley D. Disulfiram treatment of alcoholism.Br J Psychiatry 161:84-9, 1992.
Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. Journal of the American Medical Association 295(17):2003-17, 2006.
Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang CN, Jones K, Collins J, Raisch D, Casadonte P, Goldsmith RJ, Ling W, Malkerneker U, McNicholas L, Renner J, Stine S, Tusel D; Buprenorphine/Naloxone Collaborative Study Group. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone.N Engl J Med. 349(10):949-58, 2003.
Fuller RK, Branchey L, Brightwell DR, Derman RM, Emrick CD, Iber FL, James KE, Lacoursiere RB, Lee KK, Lowenstam I, et al. Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. Journal of the American Medical Association 256(11):1449-55, 1986.
Johnson RE, Eissenberg T, Stitzer ML, Strain EC, Liebson IA, Bigelow GE. A placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence. Drug Alcohol Depend. 40(1):17-25, 1995.
Ling W, Charuvastra C, Collins JF, Batki S, Brown LS Jr, Kintaudi P, Wesson DR, McNicholas L, Tusel DJ, Malkerneker U, Renner JA Jr, Santos E, Casadonte P, Fye C, Stine S, Wang RI, Segal D. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction. 93(4):475-86, 1998.
Mann K, Lehert P, Morgan MY. The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals: results of a meta-analysis. Alcohol Clin Exp Res. 2004 Jan;28(1):51-63.
O'Malley SS, Garbutt JC, Gastfriend DR, Dong Q, Kranzler HR. Efficacy of extended-release naltrexone in alcohol-dependent patients Who Are Abstinent Before Treatment. J Clin Psychopharmacol 2007;27:507–512.
O'Malley, S.S.; Jaffe, A.J.; Chang, G.; Schottenfeld, R.S.; Meyer, R.E.; and Rounsaville, B. . Naltrexone and coping skills therapy for alcohol dependence: A controlled study. . Archives of General Psychiatry. 49:881-887, 1992.
Tempesta E, Janiri L, Bignamini A, Chabac S, Potgieter A Acamprosate and relapse prevention in the treatment of alcohol dependence: a placebo-controlled study.Alcohol Alcohol. Mar- 35(2):202-9, 2000.
Thomas CP, Wallack SS, Lee S, McCarty D, Swift R. Research to Practice: Adoption of naltrexone in alcohol treatment. Journal of Substance Abuse Treatment 24(1):1-11, 2003.
Thomas CP, Wallack SS, Reif S, Haq S, Hoyt A. Adoption of buprenorphine in clinical practice. Presentation to the American Society of Addiction Medicine Annual Meeting, San Diego, April 2006.
Volpicelli, J.R.; Alterman, A.I.; Hayashida, M.; and O'Brien, C.P. . Naltrexone in the treatment of alcohol dependence. . Archives of General Psychiatry. 49:876-880, 1992.
|
