Upscaling a pharmacist-prescriber model of collaborative care for Medication Assisted Treatment for Opioid Dependence (MATOD) to address Australia’s treatment shortage

The study will test implementation strategies to maximise uptake of pharmacist–prescriber collaborative care for MATOD (the EPIC-MATOD model) , developed and tested in a previous trial (ACTRN12621000871842). . In the EPIC-MATOD model, prescribers delegate ongoing monitoring of patient progress to pharmacists, in addition to optional clinical tasks: (1) adjusting patient’s methadone or buprenorphine dose, (2) adjusting the number of unsupervised doses, and (3) reinduction back onto the same pharmacotherapy after a pre-specified number of missed doses. Pharmacists undertake regular face-to-face patient assessments at a frequency defined by the prescriber in the treatment agreement, guided by a structured review form. The study will compare a ‘basic implementation package’ (control condition) with an ‘enhanced implementation package’ (intervention condition). The basic implementation package includes: (1) Comprehensive online training covering all aspects of clinical care in the collaborative model (approximately 3-12 hours, depending on the training that has already been completed by the pharmacist). Training includes any state-based training required to provide MATOD in the pharmacist’s state, suicide prevention training, and an accredited Pharmaceutical Society of Australia (PSA) module on the collaborative care model (training components include clinical assessment, identifying and managing risk, dose adjustment, reinduction, identifying opioid toxicity and withdrawal, suitability for take-away doses, clinical documentation, patient-centred conversation, and conflict resolution) (2) Extensively reviewed clinical practice guidelines. The guidelines were developed for the EPIC-MATOD model and outline the clinical protocols, assessment tools, clinical information sharing systems and training requirements to guide patient management (3) Remote supports from a pharmacist in the research team, as required. Enhanced implementation support will include evidence-based implementation strategies drawn from the Expert Recommendations for Implementing Change (ERIC) project. This will include regular (at least fortnightly, measured through a mentor communication log) contact and support from a local pharmacist champion to facilitate the uptake and reach of the model (Identify and prepare champions). Local mentors will conduct site visits (Conduct educational outreach visits), provide remote support to pharmacists via phone/email (Facilitation), remind pharmacists to complete patient reviews on time (Remind clinicians), and provide feedback on clinical review documentation (Audit and provide feedback). The enhanced implementation support was co-designed with pharmacists and prescribers in an earlier stage of the research. The co-design process included careful analysis of pharmacist, prescriber and patient feedback (collected through qualitative interviews) from the original EPIC-MATOD trial, combined with a review potential support strategies selected from the ERIC project above that were relevant to the study design. Potential elements of a support package were then further refined through iterative interviews (e.g. face-to-face or Zoom meetings) with multiple stakeholders to determine facilitators that could form the enhanced support package. Following informed consent, all participating pharmacists will be provided with the basic implementation package. Pharmacies randomised to the intervention arm will receive, in addition to the basic implementation package, enhanced implementation support. Those pharmacies randomised to the control arm will receive enhanced support after six months (i.e. after measurement of the primary outcome).