Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network

Abstract

Background: Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices.

Methods: We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016).

Results: Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists.

Conclusions: AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD.

Figure 1.. Cascades of care for AUD and OUD.

OUD prevalence rates in Wu et al. were obtained from urban and suburban primary care clinics on the East Coast, which may not generalize to the current sample.

Figure 2.

Number of patients with specific documented AUD and OUD diagnoses

Figure 3.. Specific AUD and OUD treatments among patients with documented AUD and OUD

Among patients who received naltrexone, 10 patients with AUD and 1 patient with OUD were documented as receiving the injectable form.

Figure 4.. Variability in documented diagnoses and treatments across clinics.

Numbers below each bar indicate different primary care clinics. OUD prevalence rates in Wu et al. were obtained from urban and suburban primary care clinics on the East Coast, which may not generalize to the current sample.