Offering nurse care management for opioid use disorder in primary care: Impact on emergency and hospital utilization in a cluster-randomized implementation trial
06/2024
Journal Article
Authors:
Bobb, J. F.;
Idu, A. E.;
Qiu, H.;
Yu, O.;
Boudreau, D. M.;
Wartko, P. D.;
Matthews, A. G.;
McCormack, J.;
Lee, A. K.;
Campbell, C. I.;
Saxon, A. J.;
Liu, D. S.;
Altschuler, A.;
Samet, J. H.;
Northrup, T. F.;
Braciszewski, J. M.;
Murphy, M. T.;
Arnsten, J. H.;
Cunningham, C.O.;
Horigian, V. E.;
Szapocznik, J.;
Glass, J. E.;
Caldeiro, R. M.;
Tsui, J. I.;
Burganowski, R. P.;
Weinstein, Z. M.;
Murphy, S. M.;
Hyun, N.;
Bradley, K. A.
Volume:
261
Journal:
Drug Alcohol Depend
PMID:
38875880
URL:
https://www.ncbi.nlm.nih.gov/pubmed/38875880
DOI:
10.1016/j.drugalcdep.2024.111350
Keywords:
Cluster-randomized trial Implementation trial Massachusetts Model Office-based addiction treatment Opioid use disorder
Abstract:
BACKGROUND: Patients with opioid use disorder (OUD) have increased emergency and hospital utilization. The PROUD trial showed that implementation of office-based addiction treatment (OBAT) increased OUD medication treatment compared to usual care, but did not decrease acute care utilization in patients with OUD documented pre-randomization (clinicaltrials.gov/study/NCT03407638). This paper reports secondary emergency and hospital utilization outcomes in patients with documented OUD in the PROUD trial. METHODS: This cluster-randomized implementation trial was conducted in 12 clinics from 6 diverse health systems (March 2015-February 2020). Patients who visited trial clinics and had an OUD diagnosis within 3 years pre-randomization were included in primary analyses; secondary analyses added patients with OUD who were new to the clinic or with newly-documented OUD post-randomization. Outcomes included days of emergency care and hospital utilization over 2 years post-randomization. Explanatory outcomes included measures of OUD treatment. Patient-level analyses used mixed-effect regression with clinic-specific random intercepts. RESULTS: Among 1988 patients with documented OUD seen pre-randomization (mean age 49, 53 % female), days of emergency care or hospitalization did not differ between intervention and usual care; OUD treatment also did not differ. In secondary analyses among 1347 patients with OUD post-randomization, there remained no difference in emergency or hospital utilization despite intervention patients receiving 32.2 (95 % CI 4.7, 59.7) more days of OUD treatment relative to usual care. CONCLUSIONS: Implementation of OBAT did not reduce emergency or hospital utilization among patients with OUD, even in the sample with OUD first documented post-randomization in whom the intervention increased treatment.
