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Cited by 12Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHealth Policy Implementation Science

Implementing Group Visits for Opioid Use Disorder: A Case Series

Open access
Sokol, Randi, Albanese, Mark, Albanese, Chiara, Coste, Gerard, Grossman, Ellie, Morrill, Diana, Roll, David, Sobieszczyk, Amy +1 more·2020·Substance Abuse
DOI 10.1080/08897077.2019.1635958PMC PMC7440777
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Abstract

Background: Group-based models of Office-Based Opioid Treatment with buprenorphine-naloxone (B/N) are increasingly being implemented in clinical practice to increase access to care and provide additional therapeutic benefits. While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings. Case series: We present 4 cases of GBOT implementation across a large academic health care system, highlighting various potential approaches for providers who seek to implement GBOT and demonstrate “success” based on feasibility and sustainability of these models. For each case, we describe the pros and cons and detail the personnel and resources involved, patient mix and group format, workflow logistics, monitoring and management, and sustainability components. Discussion: The implementation details illustrate that there is no one-size-fits-all approach, although feasibility is commonly supported by a team-based, patient-centered medical home. This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system. Future research identifying the core and malleable components to implementation, their evidence base, and how they might be influenced by site-specific resources, culture, and other contextual factors can help providers better understand how to implement a GBOT model in their unique clinical environment.

Integrity signals

Registry

Crossref · 10.1080/08897077.2019.1635958

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

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  • Findingnone given

    The four models represent group-based opioid treatment implementation at six different outpatient sites.

    “It should be noted that these 4 models represent implementation of GBOT across 6 different outpatient sites.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The four group-based opioid treatment models differ in implementation elements such as who facilitates groups, the psychoeducation offered, group duration, member composition, individual versus group-only appointments, when buprenorphine-naloxone is prescribed, and which team members provide care.

    “This includes both shared medical appointments and group psychotherapy approaches, with varying implementation components: facilitators running groups, types of psychoeducation provided, duration of group, composition of group members, opportunities for individual appointments vs group-only appointments, timing of B/N prescribing, and team members involved in providing care.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Group-based office-based opioid treatment models that combine buprenorphine-naloxone prescribing with group counseling are being adopted more often in clinical practice to improve access and add therapeutic advantages.

    “Within the past decade, Group-Based Opioid Treatment (GBOT) models have begun to emerge in clinical practice and research, in which B/N prescribing is coupled with office-based group counseling. This approach increases access to care and provides additional benefits that individual prescribing of B/N cannot.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • Premisecitation

    Providing buprenorphine-naloxone in outpatient groups improves patient recovery by fostering accountability, a shared identity, and community support that individual provider-patient visits are unlikely to produce.

    “Specifically, delivery of B/N via outpatient groups enhances patient recovery by creating a sense of accountability, a shared identity, and a supportive community unlikely to be achieved through one-to-one provider-to-patient visits.16”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • Premisecitation

    Not knowing the logistical and operational specifics of implementation can make dissemination less likely.

    “Lack of knowledge about the logistical and operational details of implementation can reduce likelihood of dissemination.17”
    Quote in the paperSubstantial claim0 of 1 sources checked
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  • May combine two claims. 6
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In the authors' setting, group-based opioid treatment has been implemented within a comprehensive, well-resourced health care infrastructure.

    “In our setting, GBOT has been implemented within a comprehensive, well-resourced health care infrastructure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    The four models are not sharply separate; they overlap in characteristics and change as sites learn from one another and as local factors shift.

    “These models are not firmly distinct from one another but rather overlap in shared characteristics and are evolving as sites learn from each other and site-specific variables change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    All primary care sites in the system are National Committee for Quality Assurance Level III patient-centered medical homes.

    “All our primary care sites are National Committee for Quality Assurance (NCQA) Level III patient-centered medical homes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Patients in the system receive care from an interdisciplinary team with clearly defined roles and responsibilities who work collaboratively and to the top of their license to address complex medical and psychosocial needs.

    “Our patients receive care from an interdisciplinary team of providers with clearly defined roles and responsibilities working collaboratively and to the top of their license to provide comprehensive care addressing patients’ complex medical and psychosocial needs.27–30”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [27]

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    • cites [28]

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    • cites [29]

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    • cites [30]

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Prior research indicates that group-based opioid treatment is workable for clinicians and well received by patients, but its effectiveness is still uncertain.

    “While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings.”
    • Also stated in: § Introduction · boosted
      “A systematic review demonstrated that GBOT is feasible for providers and acceptable to patients, although the efficacy remains unclear.11”
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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    This infrastructure likely helps implementation succeed.

    “This foundation likely supports successful implementation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    This four-model framing also shows feasibility and sustainability to clinical administrators who want to expand access to care for patients with opioid use disorder.

    “This 4-model framing also demonstrates feasibility and sustainability to clinical administrators looking to expand access to care for patients with OUD.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    This model includes the ability to refer patients to higher levels of mental health and addiction services and is strengthened by ongoing communication among providers and shared resources across the health system.

    “This approach includes the capacity for referral to higher levels of mental health and addiction support services and is bolstered by ongoing provider communication and shared resources across the health system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Such an infrastructure is not necessary for group-based opioid treatment to be feasible and sustainable.

    “However, providers looking to offer GBOT should not feel that such an infrastructure is obligatory for feasibility and sustainability to occur.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims. The quote only partly states this claim.

    Interpretationreasoning

    Feasibility and sustainability across the system are supported by three underlying principles: a team-based approach, continuity and access to a higher level of addiction care, and provider support.

    “While several iterations of the GBOT model have been employed, feasibility and sustainability across the system is bolstered by three underlying principles that should not be overlooked:”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Buprenorphine-naloxone treatment for opioid use disorder is medically effective, improving treatment retention and reducing illicit opioid use.

    “Treatment of OUD with B/N has been shown to be medically effective (increasing retention in treatment and decreasing use of illicit opioids) and cost-effective.3–8”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [3]

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    • cites [4] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    Combining counseling with medication prescribing has been promoted as a best practice.

    “Coupling counseling with medication prescribing has been encouraged as a best practice, enabling providers to treat the physiologic component of addiction through medication while the behavioral component of addiction is addressed through group process and support.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Framing group-based opioid treatment into these four models helps providers who want to implement it understand possible approaches according to their resources, training, and operational and logistical opportunities and constraints.

    “Rather, the framing of GBOT into these 4 models allows providers looking to implement GBOT a way to understand potential approaches based on their resources, training, and operational and logistical opportunities and constraints.”
    Quote in the paperNot a substantial claim
13 of 13

  • The paper relies on this without support.

    No literature exists to guide providers on the practical aspects of creating and maintaining group-based opioid treatment in different outpatient settings.

    “While previous studies reported these Group-Based Opioid Treatment (GBOT) models are feasible for providers and acceptable to patients, there has been no literature to help providers with the more practical aspects of how to create and maintain GBOT in different outpatient settings.”
    “Yet, there has been little published with the purpose of helping providers manage the more practical aspects of how to create and maintain group visits for GBOT in the outpatient setting.”

  • The paper relies on this without support.

    Some sites may lack resources for higher-level addiction services, and some patients may be unable to attend a structured group format.

    “Some sites may lack the resources to provide these services, and some patients may not be able to attend such a structured format.”
2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Safford B, , Manning C. 6 characteristic of effective practice teams. Fam Pract Manag. 2012;(19)3:26–30.

Cited by

Sorted by citations

Related

Authors
Sokol, R., Albanese, M., Albanese, C., Coste, G., Grossman, E., Morrill, D., Roll, D., Sobieszczyk, A., & Schuman-Olivier, Z.
Affiliations
  • Tufts University (US)
  • Harvard University (US)
  • Cambridge Health Alliance (US)
  • Harvard Medical School, Boston, Massachusetts, USA;
Corresponding author
Sokol, Randi
ORCID
Venue
Substance Abuse
Publisher
SAGE Publications
Published
2020-04
Volume
41
Issue
2
Pages
174-180
ISSN
  • 0889-7077 (ISSN-L)
  • 1547-0164
DOI
10.1080/08897077.2019.1635958
PMC
PMC7440777
OpenAlex
W2967385786
Cited by
12
References
31
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 1
FWCI
1.84
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Substance Abuse (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Center for Complementary and Integrative Health (R33AT010125, R21AT010125)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
opioid use disorder, buprenorphine/naloxone, office-based opioid treatment, implementation of care models, outpatient addiction treatment, patient-centered medical home, team-based care, psychiatric referral, sustainability of care models
MeSH terms
Buprenorphine, Naloxone Drug Combination, Implementation Science, Shared Medical Appointments, Ambulatory Care, Humans, Narcotic Antagonists, Opioid-Related Disorders, Primary Health Care, Psychiatry, Psychotherapy, Group, Opiate Substitution Treatment

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