Primary Care Providers And Specialists Deliver Comparable Buprenorphine Treatment Quality

Abstract

In response to rising numbers of opioid overdose deaths, primary care providers have been called on to play a greater role in delivering buprenorphine treatment for opioid use disorder. However, policy makers and providers have raised concerns that expanding treatment access may reduce treatment quality and that primary care providers are not well equipped to deliver buprenorphine treatment. We investigated two research questions in response to these concerns: How did buprenorphine treatment use and quality change in North Carolina Medicaid from 2014 to 2017, and how did buprenorphine treatment quality differ between primary care providers and specialists in North Carolina Medicaid during this period? We measured buprenorphine treatment quality as patients' retention in treatment and providers' adherence to treatment guidelines. We found that the number of enrollees receiving medication treatment for opioid use disorder increased substantially, but the percentage of enrollees with the disorder receiving treatment remained low. The quality of buprenorphine treatment increased during the study period, and primary care providers provided care of comparable or higher quality compared with that of other providers. Treatment quality for buprenorphine treatment is improving, but there remains room for improvement in both use and quality. Our results support the role of primary care providers in expanding treatment for opioid use disorder.

Keywords: Buprenorphine; Health care providers; Health policy; Medicaid; Medication assisted treatment; Nonsubstance related additions; Patient care; Pharmaceuticals; Quality improvement; Quality measurement; Quality of care; Substance use disorder; methadone; opioid use disorder.

Exhibit 1. Yearly number of North Carolina Medicaid enrollees with diagnosed opioid use disorder and receiving opioid agonist treatment, 2014–17

SOURCE Authors’ analysis of Carolina Cost and Quality Initiative data. NOTE The exhibit presents the yearly number of Medicaid enrollees with opioid use disorder claims and the yearly number with either buprenorphine or methadone claims for opioid use disorder treatment.

Exhibit 2. Percent of buprenorphine treatment episodes achieving selected quality measures, by year, 2014–17

SOURCE Authors’ analysis of Carolina Cost and Quality Initiative data. NOTES Quality measures examined were 180-day retention in treatment, at least one toxicological test every thirty days, at least one evaluation and management (E&M) visit every thirty days, any E&M visit with a buprenorphine prescriber, filling a Medicaid-funded naloxone prescription, hepatitis C virus testing, HIV testing, receipt of any outpatient behavioral health services, filling a benzodiazepine prescription during buprenorphine treatment, filling a benzodiazepine prescription during buprenorphine treatment from the same provider who prescribed buprenorphine for the treatment episode, filling an opioid prescription during buprenorphine treatment, and filling an opioid prescription during buprenorphine treatment from the same provider who prescribed buprenorphine for the treatment episode. p values were calculated from a chi-square test of current year against previous year. **p < 0.05