A multisite pilot type 2 hybrid implementation-effectiveness trial of a community pharmacist-led model of collaborative care for Medication Assisted Treatment for Opioid Dependence: outcomes of the EPIC-MATOD trial

Background Australia faces a critical challenge with access to opioid dependence treatment, particularly in regional areas where treatment shortages are amplified. Objective (s): To assess outcomes of a collaborative care model for opioid dependence treatment where community pharmacists work to their full scope of practice, in partnership with prescribers. Methods Community pharmacists and prescribers were recruited from the south-eastern suburbs of Melbourne, Victoria, Australia, to take part in a prospective, multisite, Type 2 hybrid implementation-effectiveness trial. Patients received collaborative prescriber/pharmacist care over a 6-month period, with outcomes compared to a non-randomised comparison group receiving usual care. Data was collected using a mixed methods approach with outcomes mapped to the RE-AIM framework. A health economics evaluation established time and costs associated with collaborative care. Results Collaborative care provided comparable outcomes on retention in treatment (97.2 %, 35/36) compared to the control cohort (89.8 %, 44/49) with no significant differences between groups on substance use or mental or physical health outcomes. Collaborative care was associated with significant increases in treatment satisfaction and quality adjusted life years (QALYs) and was cost-effective when compared to treatment as usual. The model was implemented with relatively high fidelity, with high levels of satisfaction among pharmacists, prescribers, and patients. Considerations for broader implementation included pharmacist workload, the need for secure communication software, and a mechanism to remunerate pharmacists for their time providing clinical care. Conclusion Pharmacist-led collaborative care for opioid dependence is feasible and acceptable and can provide an at least equivalent standard of care to usual care. Further research is required to establish how collaborative care can maximise prescriber capacity at scale. Clinical Trial registration ACTRN12621000871842.