Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single‐arm, multisite feasibility study

Abstract

PurposeThe use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM‐delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings.MethodsThe study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID‐19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre‐/post‐intervention design (N = 6) was used to assess the clinic‐level outcome as patient‐days on MOUD based on patient electronic health records.FindingsAll clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient‐days on MOUD during the intervention period compared to the 6‐month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohen's d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period.ConclusionsTo expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.

Social Determinants of Health and Continuity of Medications for Opioid Use Disorder Among Patients Receiving Treatment in Rural Primary Care Settings

“…This study conducted a secondary analysis using patient electronic health record data from 6 rural clinics located in Maine, Washington, and Idaho. These clinics participated in a feasibility study (NIDA CTN-0102) aimed at expanding MOUD in rural areas 8 and provided electronic health record data from October 2019 to October 2020. The parent study applied the Health Resources and Services Administration's rural definition and verified the clinics' rural location using the "Am I Rural" tool.…”

“…The parent study applied the Health Resources and Services Administration's rural definition and verified the clinics' rural location using the "Am I Rural" tool. 8 Study participants (N = 575) included adult patients with an OUD diagnosis, using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and SNOMED code lists (Supplement C, http://links.lww.com/JAM/A475) and at least 1 MOUD prescription between October 2019 and April 2020. Most participants (99%) received buprenorphine, with only 1% prescribed naltrexone.…”

Medication treatment for opioid use disorder among rural primary care patients

“…10 The COVID-19 pandemic has worsened opioid-related problems across the country. 2 Taking advantage of a recently completed study in 6 rural primary care clinic sites, 11 we used the clinics' EHR data to estimate the prevalence of documented OUD and MOUD among rural primary care patients and compared characteristics of people with OUD who received MOUD with those who did not receive MOUD.…”

“…We conducted a secondary analysis of EHR data gathered as part of a study that investigated the feasibility of implementing a referral and care coordination model between rural primary care clinics and an external telemedicine provider for the purpose of expanding rural access to MOUD. 11 The external telemedicine providers were providers specialized in MOUD and they provided MOUD to those patients referred by the study participating sites during the 6-month study intervention period. Six sites in 3 states (Maine, Washington, and Idaho) participated in the feasibility study.…”

Primary Care Providers’ Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic

“… 8 A second study tested a care coordination model in which rural primary care providers could refer patients to off-site telehealth treatment, finding that the vast majority of providers continued to treat patients themselves, either through in-person or telehealth modalities. 22 …”