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Facilitating Extended-Release Naltrexone for Alcohol Use Disorder in Vermont Primary Care
Parker-Waters, Lindsey Patrick, Marissa Tarbi, Elise
Parker-Waters, Lindsey
Patrick, Marissa
Tarbi, Elise
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Abstract
Alcohol use disorder (AUD) is highly prevalent and associated with significant health and societal harms, yet engagement in evidence-based pharmacologic treatment remains low. Primary care is often the first point of contact for individuals with AUD and offers an opportunity to expand access to evidence-based treatment. This quality improvement project aimed to 1) evaluate the implementation of extended-release naltrexone (XR-NTX), an FDA-approved pharmacotherapy for AUD, within a Vermont primary care Pilot Clinic, and 2) assess feasibility for adoption in a Comparison Clinic. A multi-method process evaluation assessed implementation outcomes in the Pilot Clinic using the Proctor framework, including acceptability, adoption, appropriateness, feasibility, fidelity, sustainability, penetration, and cost. Three providers and two nurses participated in interviews, while four providers and two nurses completed surveys. In the Comparison Clinic, one provider and one nurse participated in interviews and surveys to assess readiness for implementation. Data were analyzed using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework across the domains of Innovation, Recipients, Context, and Facilitation, with the Mi-PARIHS Facilitation Planning Tool guiding thematic analysis and feasibility scoring. The Pilot Clinic demonstrated high acceptability and feasibility of XR-NTX within routine workflows, supported by leadership engagement, clinical champions, and structured facilitation. Penetration remained limited to a small subset of providers, reflecting workflow complexity, limited training exposure, and role delineation challenges. The Comparison Clinic showed strong perceived appropriateness and motivation to implement XR-NTX with modifiable barriers including limited staff knowledge, workflow integration uncertainty, and facilitation needs. Findings from both sites informed development of a tailored educational module to support broader dissemination. This project advances implementation methodology by integrating Proctor’s outcomes with i-PARIHS to guide feasibility assessment and facilitation planning. Results support XR-NTX as a feasible and acceptable intervention in primary care while highlighting the importance of intentional facilitation, role clarity, and clinical competency to expand access to evidence-based AUD treatment.
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2026-05-02
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Adobe PDF, 1.29 MB
- Embargoed until 2027-05-03