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. 2017 Jul/Aug;11(4):286-292.
doi: 10.1097/ADM.0000000000000310.

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

John R Brooklyn  1 , Stacey C Sigmon
Affiliations

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

John R Brooklyn et al. J Addict Med. 2017 Jul/Aug.

Abstract

Background: Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network.

Methods: In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont.

Results: Vermont's hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state's OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed.

Conclusions: Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.

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Conflict of interest statement

Conflicts of interest: There are no financial disclosures relevant to this study.

Figures

FIGURE 1
FIGURE 1
Components and referral sources for an integrated hub-and-spoke system for addiction treatment.
FIGURE 2
FIGURE 2
Treatment Needs Questionnaire (for online/digital appendix). @2015 JR Brooklyn & SC Sigmon, Licensed under CC BY-NC-ND 4.0 version 1/21/16.
FIGURE 3
FIGURE 3
Patient census data presented for Vermont’s 5 regional hubs over time (January 2013–September 2015).
FIGURE 4
FIGURE 4
Total number of individuals served in hubs and number of individuals waiting for treatment over time (January 2014–August 2015).
See this image and copyright information in PMC

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