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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

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.

J Rural Health




care coordination; medication for opioid use disorder; opioid use disorder; primary care; rural community; Telemedicine

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.

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