title: Extended-Release Naltrexone: A Qualitative Analysis of Barriers to Routine Use.
abstract: The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics). Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX.
authors.affiliation: Duke University School of Medicine.
authors.forename: Kelly
authors.initials: K
authors.lastname: Alanis-Hirsch
authors.affiliation: OHSU-PSU School of Public Health, Oregon Health & Science University.
authors.forename: Raina
authors.initials: R
authors.lastname: Croff
authors.affiliation: Center for Health Systems Research and Analysis, University of Wisconsin-Madison.
authors.forename: James H
authors.initials: JH
authors.lastname: Ford
authors.affiliation: Center for Health Enhancement System Studies, University of Wisconsin-Madison.
authors.forename: Kim
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Policy Center, Treatment Research Institute.
authors.forename: Mady
authors.initials: M
authors.lastname: Chalk
authors.affiliation: Philip R. Lee Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, University of California at San Francisco.
authors.forename: Laura
authors.initials: L
authors.lastname: Schmidt
authors.affiliation: OHSU-PSU School of Public Health, Oregon Health & Science University. Electronic address: mccartyd@ohsu.edu.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D019973:Alcohol-Related Disorders / Q000188:drug therapy*; D003692:Delayed-Action Preparations / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007407:Interviews as Topic; D009271:Naltrexone / Q000008:administration & dosage* / Q000191:economics; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000191:economics; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D036301:Qualitative Research; D014481:United States
chemical_list: D003692:Delayed-Action Preparations; D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Barriers; Consolidated framework for implementation research; Extended-release naltrexone; Naltrexone