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Mobile service delivery in response to the opioid epidemic in Philadelphia

BACKGROUND: The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care....

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Autores principales: Stewart, Rebecca E., Christian, Hanna P., Cardamone, Nicholas C., Abrams, Catherine, Drob, Caroline, Mandell, David S., Metzger, David, Lowenstein, Margaret
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687974/
https://www.ncbi.nlm.nih.gov/pubmed/38031174
http://dx.doi.org/10.1186/s13722-023-00427-5
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author Stewart, Rebecca E.
Christian, Hanna P.
Cardamone, Nicholas C.
Abrams, Catherine
Drob, Caroline
Mandell, David S.
Metzger, David
Lowenstein, Margaret
author_facet Stewart, Rebecca E.
Christian, Hanna P.
Cardamone, Nicholas C.
Abrams, Catherine
Drob, Caroline
Mandell, David S.
Metzger, David
Lowenstein, Margaret
author_sort Stewart, Rebecca E.
collection PubMed
description BACKGROUND: The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. METHODS: From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit’s services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. RESULTS: MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. CONCLUSIONS: MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00427-5.
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spelling pubmed-106879742023-11-30 Mobile service delivery in response to the opioid epidemic in Philadelphia Stewart, Rebecca E. Christian, Hanna P. Cardamone, Nicholas C. Abrams, Catherine Drob, Caroline Mandell, David S. Metzger, David Lowenstein, Margaret Addict Sci Clin Pract Research BACKGROUND: The harms of opioid use disorder (OUD) and HIV infection disproportionately impact marginalized populations, especially people experiencing homelessness and people who inject drugs (PWID). Mobile OUD service delivery models are emerging to increase access and reduce barriers to OUD care. While there is growing interest in these models, there is limited research about the services they provide, how they operate, and what barriers they face. We characterize the capacity, barriers, and sustainment of mobile OUD care services in a large city with a high incidence of OUD and HIV. METHODS: From May to August 2022, we conducted semi-structured interviews with leadership from all seven mobile OUD care units (MOCU) providing a medication for OUD or other substance use disorder services in Philadelphia. We surveyed leaders about their unit’s services, staffing, operating location, funding sources, and linkages to care. Leaders were asked to describe their clinical approach, treatment process, and the barriers and facilitators to their operations. Interview recordings were coded using rapid qualitative analysis. RESULTS: MOCUs are run by small, multidisciplinary teams, typically composed of a clinician, one or two case managers, and a peer recovery specialist or outreach worker. MOCUs provide a range of services, including medications for OUD, wound care, medical services, case management, and screening for infectious diseases. No units provide methadone, but all units provide naloxone, six write prescriptions for buprenorphine, and one unit dispenses buprenorphine. The most frequently reported barriers include practical challenges of working on a MOCU (e.g. lack of space, safety), lack of community support, and patients with substantial medical and psychosocial needs. Interviewees reported concerns about funding and specifically as it relates to providing their staff with adequate pay. The most frequently reported facilitators include positive relationships with the community, collaboration with other entities (e.g. local nonprofits, the police department, universities), and having non-clinical staff (e.g. outreach workers, peer recovery specialists) on the unit. CONCLUSIONS: MOCUs provide life-saving services and engage marginalized individuals with OUD. These findings highlight the challenges and complexities of caring for PWID and demonstrate a need to strengthen collaborations between MOCU providers and the treatment system. Policymakers should consider programmatic funding for permanent mobile OUD care services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00427-5. BioMed Central 2023-11-29 2023 /pmc/articles/PMC10687974/ /pubmed/38031174 http://dx.doi.org/10.1186/s13722-023-00427-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Stewart, Rebecca E.
Christian, Hanna P.
Cardamone, Nicholas C.
Abrams, Catherine
Drob, Caroline
Mandell, David S.
Metzger, David
Lowenstein, Margaret
Mobile service delivery in response to the opioid epidemic in Philadelphia
title Mobile service delivery in response to the opioid epidemic in Philadelphia
title_full Mobile service delivery in response to the opioid epidemic in Philadelphia
title_fullStr Mobile service delivery in response to the opioid epidemic in Philadelphia
title_full_unstemmed Mobile service delivery in response to the opioid epidemic in Philadelphia
title_short Mobile service delivery in response to the opioid epidemic in Philadelphia
title_sort mobile service delivery in response to the opioid epidemic in philadelphia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687974/
https://www.ncbi.nlm.nih.gov/pubmed/38031174
http://dx.doi.org/10.1186/s13722-023-00427-5
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