Table 3.

Changes in organizational capacity barriers to implementing the continuum of care for opioid and alcohol use disorders across implementation phases

Construct	Theme	Barrier	Frequency
			T1	T2	T3
Fiscal and Economic Resources	Billing/Cost of Service	Reimbursement for Services	45	14	14
		Medication Reimbursement	78	57	71
		Funding Additional Staff	44	29	50
		Insurance Barriers	44	29	57*
		Funding Stability	33	43	50
	Time	Time to Commit to Treating OAUD Patients	89	86	86
		Time for Paperwork	11	21	7
		Wait for Appointment Times	0	43	57
Workforce and Human Resources	Motivation	Providers Lacking Motivation	56*	57	29
	Self-Efficacy	Providers Not Feeling Knowledgeable	67	50	43
	Training	Worry that Training will not be enough	78	82	86*
	Staff Configuration	Specialty Clinic	33	21	14
		Dedicated Provider	89	29	50
	Quantity of Staff	Lack of Staff	89	57	43
		Staff Turnover/Training	78	29	14
Physical Infrastructure	Physical Space	Need for More Clinic Space	33	37	14*
		Distance Between Providers	22	0	0
	Equipment/Supplies	Not Having Enough Medication	56	14	14
		Equipment Problems	0	7	14
Intra/Inter-organizational Relationships	Administration-Clinic Staff Collaboration	Need for Better Communication within Clinic	44	42	39
	Need for Referral Network	Availability of Specialty OAUD Clinics and Providers	56	29	21
Data and Informational Resources	Electronic Health Record	Problems with Appointment Reminders	11	14	36
		Difficulty with Registry Integration	0	43	57
System Boundaries and Size	Clinic Location and Attributes	Clinic Hours	0	21	14
		Clinic Not Appropriate Setting for OAUD Patients	33	43	21
	Population Demographics	Large Homeless Population	55	43	43
		Many Patients with Comorbidities	67	43	43
		Fear of Attracting Too Many OAUD Patients	67	29	29
		Fear of Not Treating Enough OAUD Patients	22	50	29
Governance and Decision-Making Structure	Policies and Procedures	State/County Policies	11	12	14
		Clinic Policies	78	57	57
		Lack of Policy Regarding OAUD Treatment	33	14	14
Organizational Culture	Fit with Mission Values	Alternative Treatment Model Would be Better Fit	11	14	0
	Leadership	Fear Leadership will not ensure OAUD Treatment	33	14	14

No Barrier=0 Small Barrier=1–25% Small-to-Medium Barrier=26–50% Medium-to-Large Barrier=51–75% Large Barrier=76–100%

^*Barrier color adjusted based on feedback from providers; percentage reflects original size. Note: T1 = preparation time point; T2 = practice time point, T3 = full implementation time point.