Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation.


BACKGROUND:Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? METHODS:To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components. RESULTS:We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. CONCLUSION:While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.





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Publication Info

Sokol, Randi, Mark Albanese, Aaronson Chew, Jessica Early, Ellie Grossman, David Roll, Greg Sawin, Dominic J Wu, et al. (2019). Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation. Addiction science & clinical practice, 14(1). p. 47. 10.1186/s13722-019-0176-y Retrieved from

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Gregory Eshleman Sawin

Associate Professor in Family Medicine and Community Health

My work is a reflection of a core value in social justice and a passion to increase health equity. Most of my academic career has been as an educator, serving as a family medicine residency director for 10 years prior to joining Duke. Having started my career in Massachusetts, where universal coverage started in 2007, I have had a focus in primary care transformation and value based care, with special attention to doing so in residency clinics. I’m eager to use my position as Vice Chair for Education and Faculty Development in the Department of Family Medicine and Community Health to coordinate efforts across its five divisions and growing research group to build “learning systems” that adopt continuous improvement culture in all that we do.

Research interests: health equity, team based care, primary care transformation, leadership and improvement science and group based opioid treatment.

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