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