Care Coordination between Rural Primary Care and Telemedicine to Expand Medication Treatment for Opioid Use Disorder: Results from a Single-arm, Multisite Feasibility Study

Publication Type
Journal Article
Year of Publication
Hser, Yih-Ing; Mooney, Larissa J; Baldwin, Laura-Mae; Ober, Allison; Marsch, Lisa A; Sherman, Seth; Matthews, Abigail; Clingan, Sarah; Fei, Zhe; Zhu, Yuhui; Dopp, Alex; Curtis, Megan E; Osterhage, Katie P; Hichborn, Emily G; Lin, Chunqing; Black, Megan; Calhoun, Stacy; Holtzer, Caleb C; Nesin, Noah; Bouchard, Denise; Ledgerwood, Maja; Gehring, Margaret A; Liu, Yanping; Ha, Neul Ah; Murphy, Sean M; Hanano, Maria; Saxon, Andrew J
J Rural Health
Date Published
2023 Apr 19
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.