Preliminary results of the evaluation of the California Hub and Spoke Program

Kendall Darfler; José Sandoval; Valerie Pearce Antonini; Darren Urada

doi:10.1016/j.jsat.2019.07.014

Preliminary results of the evaluation of the California Hub and Spoke Program

J Subst Abuse Treat. 2020 Jan:108:26-32. doi: 10.1016/j.jsat.2019.07.014. Epub 2019 Aug 1.

Authors

Kendall Darfler¹, José Sandoval², Valerie Pearce Antonini³, Darren Urada⁴

Affiliations

¹ University of California, Los Angeles Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd, Los Angeles, CA 90025, United States of America. Electronic address: kdarfler@mednet.ucla.edu.
² University of California, Los Angeles Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, United States of America. Electronic address: josesandoval@mednet.ucla.edu.
³ University of California, Los Angeles Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, United States of America. Electronic address: vpearce@mednet.ucla.edu.
⁴ University of California, Los Angeles Integrated Substance Abuse Programs, David Geffen School of Medicine at UCLA, United States of America. Electronic address: durada@mednet.ucla.edu.

PMID: 31400985
DOI: 10.1016/j.jsat.2019.07.014

Abstract

In August 2017, California launched the Hub and Spoke Program to address the growing number of opioid overdose deaths in the state. The program connects opioid treatment programs ("hubs") with office based opioid treatment settings, like primary care clinics ("spokes") to build a network of treatment expertise and referral resources. A key objective of this program is to expand access to medications for opioid use disorders (MOUD), with a particular focus on getting more buprenorphine into spokes. This article describes the preliminary results of the evaluation of the California Hub and Spoke program. Using a mixed methods approach, this portion of the evaluation measures changes in numbers of MOUD patients and providers, and barriers and facilitators to implementation. Findings reveal that, in the first 15 months of the program, 3480 new patients started buprenorphine in 118 spokes, increasing treatment initiations by 94.7% over baseline. The number of waivered spoke providers also increased 52.4% to 268. Although these data demonstrate promising growth in the network, challenges to expanding treatment access remain. Provider activity was among the most notable. Despite growth in the number of spoke providers with waivers to prescribe buprenorphine, only 68.7% (n = 184) were actively prescribing to patients. A survey of providers found that those who were not yet using their waivers lacked the confidence and mentorship they needed to prescribe. Provider knowledge and attitudes toward MOUD, fear of legal consequences, and limited patient outreach were also contributing factors. Recommendations for strengthening Hub and Spoke program implementation include facilitating mentor linkage for prescribers, expanding the support offered to spoke providers, and offering additional training and technical assistance aimed at provider stigma. Efforts to address these recommendations are described in a companion paper (Miele et al., under review).

Keywords: Buprenorphine; California State Targeted Response; Hub and spoke; Medications for opioid use disorders; Opioid.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Buprenorphine / therapeutic use
California
Drug Overdose / mortality*
Health Services Accessibility / organization & administration*
Humans
Narcotic Antagonists / therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders / drug therapy
Practice Patterns, Physicians' / statistics & numerical data*
Primary Health Care / organization & administration*
Program Evaluation*

Substances

Narcotic Antagonists
Buprenorphine