Table 2 Clinical decision support algorithm
Critical decision point | Critical status | Plan |
|---|---|---|
Week 0 (CDP #1) | Symptomatic | Initiate buprenorphine treatment: adjust dose to lower end of therapeutic dose range |
Week 2 (CDP #2) | Full response2 | Continue current dose |
Partial response | Continue current dose OR Increase dose3 | |
Minimal or nonresponse | Increase dose | |
Week 4 (CDP #3) | Full response | Go to continuation phase if full response is sustained for at least 4Â weeks. Otherwise, continue current does |
Partial response | Increase dose and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Continue dose and counsel regarding behaviors to support recovery (including mutual help group attendance) | |
Minimal or nonresponse | Increase dose and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Continue dose and counsel regarding behaviors to support recovery (including mutual help group attendance) | |
Week 6 (CDP #4) | Full response | Go to continuation phase if full response is sustained for at least 4Â weeks. Otherwise, continue current does |
Partial response | Increase dose and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Divide daily dose in half, take medication BID and counsel regarding behaviors to support recovery (including mutual help group attendance) | |
Minimal or nonresponse | Increase dose and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Divide daily dose in half, take medication BID and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Refer to specialty care. Continue current dose until patient is evaluated by specialist | |
Week 8 (CDP #5)1 | Full response | Go to continuation phase if full response is sustained for at least 4Â weeks. Otherwise, continue current does |
Partial response | Increase dose and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Divide daily dose in half, take medication BID and counsel regarding behaviors to support recovery (including mutual help group attendance) | |
Minimal or nonresponse | Divide daily dose in half, take medication BID and counsel regarding behaviors to support recovery (including mutual help group attendance) OR Refer to specialty care. Continue current dose until patient is evaluated by specialist | |
Week 10 (CDP #6) | Full response | Go to continuation phase if full response is sustained for at least 4Â weeks. Otherwise, continue current does |
Partial response | Increase dose OR Counsel regarding behaviors to support recovery (including mutual help group attendance) OR Refer to specialty care. Continue current dose until patient is evaluated by specialist | |
Minimal or nonresponse | Refer to specialty care. Continue current dose until patient is evaluated by specialist | |
Week 12 (CDP #7) | Full response | Go to continuation phase if full response is sustained for at least 4Â weeks. Otherwise, continue current does |
Partial response | Increase dose OR Counsel regarding behaviors to support recovery (including mutual help group attendance) OR Refer to specialty care. Continue current dose until patient is evaluated by specialist | |
Minimal or nonresponse | Refer to specialty care. Continue current dose until patient is evaluated by specialist |