Stakeholder-informed recommendations for patient-centered medication service delivery for stimulant use disorder: a qualitative study

BACKGROUND: Although stimulant use disorder (StUD) is on the rise in the United States, few receive treatment. There are no FDA-approved medication treatments, despite evidence of clinical efficacy. Substance use treatment occurs within a complex landscape, with implementation of medication treatments requiring coordination among diverse partners and careful consideration of individual, organizational, and societal-level influences. The aim of this study was to identify partner- and theory-informed implementation strategies to support widespread adoption of medications for StUD. METHODS: Seven focus groups and four interviews were conducted with patients and providers in diverse substance use treatment settings (12 patients, 13 providers; 25 total participants). Rapid qualitative analysis was used to distill and compare findings across patient and provider samples, and findings were critically reviewed for alignment with the Expert Recommendations for Implementing Change taxonomy in accordance with recommendations for mapping implementation strategies. RESULTS: Participants highlighted multiple strategies that were categorized into three classes: capacity-building, integration, and implementation processes. Capacity-building strategies included training and education for providers and patients, families, and communities to reduce stigma, improve the patient-centeredness of care, and increase medication demand. Integration strategies focused mainly on organizational-level strategies such as mandating change, modifying record systems, and adding peers to care teams to enhance patient-centered care through required training, use of treatment plans, and preparing patients to be active participants in their treatment. Implementation processes strategies focused on the need for team meetings and internal/external networking to reduce siloed work among care teams and improve communication with patients. CONCLUSIONS: We report on a model for incorporating patient and provider perspectives and considering multilevel contextual factors to design implementation strategies for feasibility and acceptability across diverse SUD treatment settings. Findings highlight the importance of patient-centered approaches to medication delivery, particularly for StUD, to increase treatment engagement and adherence.