Vanderbilt University Medical Center
People receiving buprenorphine-naloxone (bup-nx) for opioid use disorder often face changes in cravings, withdrawal, and return to use risk between clinic visits, but their care team may not know about these changes until the person misses an appointment or returns to drug use. Measurement-based care (MBC) uses brief, repeated check-ins from patients to make these between-visit changes visible. This study tests "Bup-MBC," a strategy that sends patients short questionnaires through their patient portal or by text before and between visits, gives them immediate supportive feedback, shares summary information with their prescriber in the electronic health record, and offers an option to request earlier contact if concerns arise. The study will include providers and patients at outpatient addiction clinics at Vanderbilt University Medical Center, randomly assigned to either receive Bup-MBC or usual care, and followed for 6 months. The main goal is to determine whether Bup-MBC can be practically delivered in routine addiction clinics and whether patients and providers use it.
Bup-MBC is an electronic health record-embedded implementation strategy designed to support evidence-based buprenorphine-naloxone (bup-nx) treatment for opioid use disorder (OUD) by integrating patient-reported outcome measures (PROMs) and related indicators into routine outpatient addiction care. The strategy comprises four components: (1) structured between-visit PROMs assessing withdrawal, craving, medication adherence, medication side effects, opioid overdose risk, other substance use, global treatment improvement, and recovery community connection; (2) automated non-punitive patient feedb…
Inclusion Criteria: * (1) Adult (age ≥18); (2) Active bup-nx prescription under a participating prescriber at one of the five VUMC addiction clinics (Bridge Clinic, Vanderbilt Recovery Clinic, or Firefly Clinic); (3) Enrolled in and active in the respective clinic Exclusion Criteria: * NA
Electronic health record-embedded implementation strategy comprising four components: (1) brief repeated PROMs delivered via patient portal or secure text (domains: withdrawal, craving, bup-nx adherence, medication side effects, opioid overdose risk, other substance use, global treatment improvement, recovery community connection); (2) automated non-punitive tailored patient feedback following each PROM; (3) longitudinal EHR-embedded clinician-facing summaries with non-directive clinical decision support prompts; (4) opt-in between-visit outreach pathway with predefined safety triggers for urgent follow-up. PROM frequency is adapted to treatment phase and clinical stability.
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