Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

Abstract

Introduction: Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. Methods: Electronic health record data were used to identify adults with ≥1 primary care visit in 1 of 2 study clinics in a Pacific Northwest academic health system between September 1, 2015 and August 31, 2017 (n = 23,372). Rates of documented OUD diagnosis were calculated. Multivariate logistic regression estimated odds ratios of MAT initiation, defined as ≥1 electronic health record order for buprenorphine or naltrexone, by patient covariates. Results: Seven percent of the study sample had an OUD diagnosis. Of those patients, 32% had ≥1 MAT order. Patients with documented psychiatric diagnoses or tobacco use had higher odds of initiating MAT (odds ratio [OR] = 1.62, P = .0003; OR = 2.46, P < .0001, respectively). Uninsured, Medicaid, and Medicare patients had lower odds than those commercially insured (OR = 0.53, 0.38, and 0.31, respectively; P < .0001). Patients who were older, of a race/ethnicity other than non-Hispanic white, had documented diabetes, and had documented asthma or chronic obstructive pulmonary disease showed lower odds of initiation. Discussion: MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.

Mental Health and Psychosocial Needs of Patients Being Treated for Opioid Use Disorder in a Primary Care Residency Clinic

“…Our sample of 100 new patients receiving MOUD in a family medicine residency clinic reported considerably high levels of comorbid mental health and psychosocial concerns including depression, anxiety, and PTSD. These findings are consistent with the previous research that has documented high rates of comorbid mental health conditions in people with OUD, 16,32,33 as well as those specifically seeking MOUD treatment in primary care. 19,34…”

“…12 Estimates of the prevalence of comorbid psychiatric disorders in the literature range from 23% 13 to 90%, 14 with most reported to be 45% to 80%. 9,[15][16][17][18][19] In addition to anxiety and affective disorders, 14,[20][21][22] patients with OUD experience high rates of posttraumatic stress disorder 23 and sexual or physical abuse. 18 Given the large overlap between mental illness and substance use disorders, one may posit that having comorbid diagnoses may be a risk factor for early treatment discontinuation.…”

Addiction Medicine Practice-Based Research Network (AMNet): Assessment Tools and Quality Measures

“…Once medication is initiated, it is important to keep the patient engaged in treatment to monitor their experience and make modifications if necessary, such as titrating up or down or addressing any side effects. 46 Engagement and retention in treatment are necessary to achieve optimal patient outcomes, including decreased involvement with the criminal justice system, improved employment outcomes, and lower substance use. 38 Regarding OUD, retention on medication for OUD, particularly methadone and buprenorphine, is associated with decreased mortality both from overdose and all-cause mortality, with the risk of overdose increasing significantly after discontinuation of medication.…”

Practice-Based Research Today: A Changing Primary Care Landscape Requires Changes in Practice-Based Research Network (PBRN) Research

“…Researchers in Washington applied these same tools of practice facilitation and quality improvement to a vexing problem for primary care physicians, prescribing opioids for chronic pain, and successfully improved clinical work-life for these physicians. 14 Cantone et al 15 used EHR data to study medication assisted treatment uptake for opioid addiction in 2 practices, revealing important predictors to assist further research and clinical care.…”