Care Coordination between Rural Primary Care and Telemedicine to Expand Medication Treatment for Opioid Use Disorder: Results from a Single-arm, Multisite Feasibility Study
2023 Apr 19
Journal Article
Authors:
Hser, Y.I.;
Mooney, L.J.;
Baldwin, L.M.;
Ober, A.;
Marsch, L.A.;
Sherman, S.;
Matthews, A.;
Clingan, S.;
Fei, Z.;
Zhu, Y.;
Dopp, A.;
Curtis, M.E.;
Osterhage, K.P.;
Hichborn, E.G.;
Lin, C.;
Black, M.;
Calhoun, S.;
Holtzer, C.C.;
Nesin, N.;
Bouchard, D.;
Ledgerwood, M.;
Gehring, M.A.;
Liu, Y.;
Ha, N.Ah;
Murphy, S.M.;
Hanano, M.;
Saxon, A.J.
Secondary:
J Rural Health
PMID:
37074350
URL:
https://pubmed.ncbi.nlm.nih.gov/37074350/
Keywords:
care coordination; medication for opioid use disorder; opioid use disorder; primary care; rural community; Telemedicine
Abstract:
PURPOSE: The 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.METHODS: The 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.FINDINGS: All 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.CONCLUSIONS: To 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.
