Provider and Patient-panel Characteristics Associated With Initial Adoption and Sustained Prescribing of Medication for Opioid Use Disorder

Abstract

Objectives:Limited information is available regarding provider- and patient panel-level factors associated with primary care provider (PCP) adoption/prescribing of medication for opioid use disorder (MOUD).Methods:We assessed a retrospective cohort from 2015 to 2018 within the Pennsylvania Medicaid Program. Participants included PCPs who were Medicaid providers, with no history of MOUD provision, and who treated ≥10 Medicaid enrollees annually. We assessed initial MOUD adoption, defined as an index buprenorphine/buprenorphine-naloxone or oral/extended release naltrexone fill and sustained prescribing, defined as ≥1 MOUD prescription(s) for 3 consecutive quarters from the PCP. Independent variables included provider- and patient panel-level characteristics.Results:We identified 113 rural and 782 urban PCPs who engaged in initial adoption and 36 rural and 288 urban PCPs who engaged in sustained prescribing. Rural/urban PCPs who issued increasingly larger numbers of antidepressant and antipsychotic medication prescriptions had greater odds of initial adoption and sustained prescribing (P < 0.05) compared to those that did not prescribe these medications. Further, each additional patient out of 100 with opioid use disorder diagnosed before MOUD adoption increased the adjusted odds for initial adoption 2% to 4% (95% confidence interval [CI] = 1.01–1.08) and sustained prescribing by 4% to 7% (95% CI = 1.01–1.08). New Medicaid providers in rural areas were 2.52 (95% CI = 1.04–6.11) and in urban areas were 2.66 (95% CI = 1.94, 3.64) more likely to engage in initial MOUD adoption compared to established PCPs.Conclusions:MOUD prescribing adoption was concentrated among PCPs prescribing mental health medications, caring for those with OUD, and new Medicaid providers. These results should be leveraged to test/implement interventions targeting MOUD adoption among PCPs.

Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model

“…Recognizing the need to increase access to MOUD and integrated care, a multidisciplinary team at the University of Pittsburgh partnered with the Pennsylvania Department of Human Services (DHS) to initiate the Rural Access to Medication Assisted Treatment (MAT 1 ) in Pennsylvania Project (also known as Project RAMP). Project RAMP was supported by a 4-year Research Demonstration and Dissemination grant led by the DHS and funded by the Agency for Healthcare Research and Quality (AHRQ #: R18-HS025072) that aimed to increase rural access to MOUD by implementing an ICM (Cochran et al, 2019(Cochran et al, , 2022Cole et al, 2021). The goal of the Project RAMP ICM was to improve provider capacity to identify, assess, manage, and treat OUD by promoting a team-based approach to patient care and alleviating the PCP from some patient management responsibilities.…”

Examining the Primary Care Experience of Patients With Opioid Use Disorder: A Qualitative Study

“…5,9,10 Moreover, primary care's broad geographic reach and telehealth infrastructure may be particularly important in expanding OUD treatment in underresourced areas that have been disproportionately affected by the opioid crisis. [11][12][13][14][15][16][17] However, few PCPs prescribe medications to treat OUD, and many who do provide MOUD do so to only a small volume of patients. [18][19][20] Understanding both patient and PCP experiences with MOUD is critical to expanding access to evidence-based OUD care in the primary care setting.…”

“…Several characteristics of primary care, including expertise in chronic disease management and a holistic approach to patient health, are key components of effective OUD care 5,9,10 . Moreover, primary care’s broad geographic reach and telehealth infrastructure may be particularly important in expanding OUD treatment in underresourced areas that have been disproportionately affected by the opioid crisis 11–17 …”