A novel rural hospital/clinic-system practice-based research network: the Rural Addiction Implementation Network (RAIN) initiative and its goals, implementation, and early results

• Published in: The American journal of drug and alcohol abuse 2024-11, Vol.50 (6), p.786-12
• Main Authors: Hafen, Kody, Wallace, Harlan, Fritz, Kayla, Fordham, Cole, Haskell, Tyler, Kelley, A Taylor, Jones, Audrey L, Cochran, Gerald, Gordon, Adam J
• Format: Article
• Language: English
• Subjects: Hospitals, Rural - organization & administration; Humans; Opioid-Related Disorders; Rural Health Services - organization & administration; Rural Population; Substance-Related Disorders - therapy
• ISSN: 0095-2990; 1097-9891; 1097-9891
• DOI: 10.1080/00952990.2024.2394487

Rural and frontier communities face high rates of opioid use disorders (OUDs). In 2021, the Rural Addiction Implementation Network (RAIN) sought to establish a rural hospital/clinic-system practice-based research network (RH-PBRN) to facilitate implementation of evidence-based addiction-related prevention, treatment, and recovery (PTR) services to reduce the morbidity of OUD and substance use disorder (SUD) in rural communities. To describe the goals and implementation of PTR activities of RAIN, a novel RH-PBRN. RAIN identified teams of external/internal facilitators at four rural hospitals/clinic-networks to achieve at least 15 PTR activities involving OUD and other SUDs. RAIN utilized an implementation-facilitation approach: facilitators assessed the implementation environment and promoted interventions to overcome barriers to PTR implementation. Other interventions included site visits, community of learning calls, and e-communication. RAIN assessed and recorded facilitators and barriers to implementation, milestone attainment, and outcomes of PTR activities. At 18 months, we queried facilitators about the fidelity and implementation of RAIN activities. RAIN established an HP-PBRN in four sites (Idaho, Montana, Utah, and Wyoming). Within the HP-PBRN, 20 PTR activities were established (  = 7,  = 10,  = 3; range 3-7 per site). Barriers to implementation of PTR activities included competing clinical demands, especially due to COVID-19, lack of dedicated effort for staff at sites, and stigma of addiction and its treatment. Facilitators of implementation included the use of trained expert facilitators and communication between the sites. RAIN implemented 20 addiction-related PTR activities in four rural hospitals/clinic-networks. RAIN's intervention model could be replicated to address addiction-related harms in other rural communities.