Utilizing the Practical Robust, Implementation and Sustainability Model to Explore the Primary Care Setting Contextual Determinants of Implementing Patient-Reported Outcomes Measures to Support Opioid Use Disorder Care

Background: Patients with opioid use disorder (OUD) experience low treatment retention in primary care. Measurement-based care informed by patient-reported outcome measures (PROMs) is an evidence-based intervention to improve OUD outcomes. The study explored the key contextual factors to support the future planning of a PROM-based intervention package to improve primary care-based OUD treatment retention. Method: A qualitative contextual inquiry used the Practical, Robust Implementation and Sustainability Model to assess the following contextual domains: Perspective of Intervention Characteristics, Partner Characteristics, and Implementation and Sustainability Infrastructure. Data were collected through interviews with system administrators, clinicians, and patients. Prioritized themes were triangulated with focus groups of community members with lived experience or interest in substance use care. Rapid thematic analysis identified emergent themes. Results: We conducted 21 interviews (6 administrators, 10 clinicians, 5 patients) and two focus groups (22 community members). Fifteen themes emerged which fell into three categories: (1) maintaining patient trust while PROMs are integrated into workflows, (2) perspectives on PROM content and use, and (3) implementation considerations. PROMs were viewed as tools for enhancing communication, tracking recovery in a holistic and individualized way, and informing care decisions at the individual- and system-level. Patients emphasized trust, confidentiality, and potential negative consequences of PROM results being stored in health records. Clinicians highlighted the need for workflow integration and result interpretation support. All groups recommended PROMs be embedded in the electronic health record with collection managed by the integrated substance use treatment counselors. Conclusions: The qualitative contextual inquiry identified partner perspectives relevant to the implementation of PROMs in primary care settings. The patient desire for trust and confidentiality may be at odds with integrating PROM results into existing systems. Continued engagement with implementation partners in a process of co-creation may improve implementation to support patient-centered, recovery-oriented care and enhance retention in primary care settings.