Integrating Treatment for Mental Disorders in Methadone Clinics

Background

Ukraine is a middle-income country profoundly impacted by opioid use disorders. Despite opioid agonist therapies (OAT) like buprenorphine and methadone being available since 2004, treatment outcomes have been undermined by a number of patient-, clinic- and structural-level barriers. Currently, OAT is prescribed in Narcology Centers, an addiction subspecialty of Psychiatry. Despite similar training by Narcologists and Psychiatrists, the siloed and fragmented Semashko Soviet-style healthcare system legacy has resulted in OAT patients not receiving treatment for co-occurring psychiatric disorders (COD) unless they are referred offsite to Psychiatric Centers. Depression severe enough to warrant pharmacotherapy with first-line selective serotonin reuptake inhibitors (SSRI) now exceeds 50% of OAT patients, yet only 11% have been diagnosed and 1.2% are prescribed SSRIs. This leaves considerable room for improvement in managing COD.

Aims

The aim of this project is to study the effectiveness of the modified SBIRT, where instead of offsite psychiatric referral, depression is treated onsite using SSRIs. Also, we will use ECHO (Extension for Community Healthcare Outcomes), a collaborative learning process, to facilitate mSBIRT activities and reinforce integration of COD services in OAT clinics.To enhance ECHO implementation, evidence-based pay-forperformance (P4P) intervention, aligned with Ukraine’s health reform, will be added to determine if incremental benefits are derived from this EBP, in an effort to strengthen and support ongoing healthcare reform efforts in Ukraine.

Project plan

1. To compare both service-level (screening and brief intervention adoption and penetration) and patient-level (SSRI initiation, OAT drop-out and psychiatric quality of life) outcomes in 1,350 patients with opioid use disorders receiving OAT from 4 regions (clusters) and 12 clinical settings using a randomized, cluster-controlled design over 24 months. Before site randomization, all OAT clients at each participating site will have baseline assessments followed by site randomization to receive standard of care (N=450) versus integrated care using ECHO-COD facilitation with (N=450) or without (N=450) P4P incentives;

2. Using a multi-level implementation science framework, to examine the contribution of client, clinician and organizational factors that contribute to the primary and secondary outcomes;

3. To conduct a cost-effectiveness analysis (CEA) of integrating COD services into OAT clinics, with or without P4P, compared to a control group of OAT sites.

Publications and output

You may visit the project website for more information.

Funding organisations

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