November 3, 2017
Multidisciplinary and coordinated care delivery models effectively provide opioid use disorder treatment and increase access to medication-assisted treatment in primary care, according to data published in PLOS One.
“It’s hard to convince primary care physicians to do this work when they’re already busy and they don’t have additional addiction-related training or experience,” Pooja Lagisetty, MD, from the division of general internal medicine and the Institute for Health Policy and Innovation at the University of Michigan, Ann Arbor, and VA Ann Arbor Healthcare System, said in a press release. “But, if we can learn from others and find a way to offer physicians logistical support, then maybe it’s possible. There is a major need to do this.”
People who need addiction care outnumber the physicians willing to provide medication-assisted treatments (MATs) like buprenorphine and methadone in primary care, despite prior research showing that MAT can reduce mortality for patients with opioid use disorder. Researchers compiled data on evidence-based, primary care MAT interventions and program structures and processes that were associated with improved patient outcomes using clinical databases. They reviewed randomized controlled trials and observational studies that assessed MAT for adult patients with opioid use disorder to determine what kinds of primary care-based models may help guide future policy and implementation in primary care settings.
Lagisetty and colleagues included 35 interventions that tested MAT in primary care settings across eight countries in their systematic review. Analysis showed that patients were more likely to have successful opioid addiction treatment when their PCP worked with teams of nurses, medical assistants, social workers and pharmacists to deliver MAT. The successful interventions featured joint multidisciplinary and coordinated care by physician and nonphysician provider delivery models to offer MAT. Seven studies showed that 60% or more of patients continued their MAT regimen for 3 months or longer. Not all successful programs were the same in reported patient outcomes, processes and tools used, but they used similar key design factors, such as:
- integrated clinical teams with support staff — usually advanced practice nurses and pharmacists — as clinical care managers;
- patient agreements with providers that outlined consequences for continued drug misuse; and
- home inductions of buprenorphine to make treatment more convenient.
Lagisetty noted that it makes sense to provide MAT in primary care because the results are similar to providing it in specialty care. In addition, patients may be more likely to seek help from their PCP because of the lack of stigma and their ability to address other health concerns as well, according to the release.
“I don’t think that many primary care physicians went into medicine with a desire to focus on treating addiction. However, opioid addiction is increasingly becoming common in our practices and our patients are struggling to find help,” Lagisetty said. “Primary care doctors don’t need to all be treating 100 patients. It can just be five. We should just have the medication in our tool box and be able to screen and potentially treat patients in our own setting.” – by Savannah Demko
Disclosures: The authors report no relevant financial disclosures.