External Facilitation to Increase Prescribing of AUD Medications in the Psychiatric Setting

ABSTRACT
Patients with major mental illness (MMI; major depressive, bipolar, schizophrenia spectrum, other psychotic
disorders; posttraumatic stress disorder) are diagnosed with alcohol use disorder (AUD) at higher rates than the
general population and experience negative consequences and long-term suffering as a result. There are FDA
approved medications for AUD (MAUD) that have demonstrated efficacy. That these medications are underutilized in
MMI patients with comorbid AUD represents a gap in care: evidence-based AUD treatments exist but MMI patients –
many from marginalized racial, ethnic, and SES groups - are largely excluded from benefiting from them. In primary
care and mental health settings, prescribers report that MAUD is best provided in specialty addictions service settings
even though it is hard to connect with these services for MMI patients. However, the psychiatric treatment setting can
easily offer MAUD. Many MMI patients are highly connected to their psychiatry treatment providers. They are taking
psychiatric medications prescribed by their psychiatry treatment team; MAUD could easily be offered and monitored in
this context. APA practice guidelines state that MAUD can have efficacy outside of specialty addictions services.
Services in psychiatry treatment settings are provided by a team in which prescribers focus on medication treatments
in brief monthly appointments and non-prescribing clinicians provide psychosocial interventions in more frequent
appointments. Implementing a process that identifies patients, educates them on MAUD, prescribes MAUD and
monitors use, and integrates MAUD with other psychotherapies offers the best chance for increasing MMI patients’
access to MAUD.
This project will pilot test an implementation facilitation (IF) intervention to increase MAUD education and
prescribing for MMI/AUD patients in three psychiatry treatment clinics. Guided by the integrated Promoting Action on
Research Implementation in Health Services (i-PARIHS) framework, an external facilitator will work with each clinics’
internal champion to (1) provide clinic level education on MAUD in non-specialty care settings, (2) provide clinic level
training in using a standardized AUD screen, documenting screening results in the EHR, and documenting AUD
diagnosis in the EHR, (3) help internal champions use an audit and feedback system for weekly review of MAUD
education and prescribing, (4) help internal champions do weekly care coordination of MMI/AUD patients, and (5)
make educational materials on MAUD available on site to MMI patients so they are informed about these treatment
options. Internal champions and clinics will have access to consultation from a MAUD clinician expert. These activities
will take place across pre-implementation and implementation phases and will be followed by a post-IF sustainment
period during which clinics and champions continue implementation on their own. Formative Evaluation activities will
take place throughout; at the end of the sustainment phase, MAUD outcomes will be assessed.

Grant Number: 5R34AA032051-02
NIH Institute/Center: NIH
Principal Investigator: MELANIE BENNETT