Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

Yih-Ing Hser¹, Larissa J Mooney^{1

2}, Laura-Mae Baldwin³, Allison Ober⁴, Lisa A Marsch⁵, Seth Sherman⁶, Abigail Matthews⁶, Sarah Clingan¹, Zhe Fei⁷, Yuhui Zhu¹, Alex Dopp⁴, Megan E Curtis¹, Katie P Osterhage³, Emily G Hichborn⁵, Chunqing Lin⁸, Megan Black¹, Stacy Calhoun¹, Caleb C Holtzer⁹, Noah Nesin¹⁰, Denise Bouchard¹¹, Maja Ledgerwood¹², Margaret A Gehring¹³, Yanping Liu¹⁴, Neul Ah Ha¹⁵, Sean M Murphy¹⁶, Maria Hanano¹, Andrew J Saxon^{17

18}

Affiliations

¹ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA.
² VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
³ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
⁴ RAND Corporation, Santa Monica, California, USA.
⁵ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.
⁶ Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA.
⁷ Department of Biostatistics, University of California, Los Angeles, California, USA.
⁸ Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA.
⁹ Providence, Colville, Washington, USA.
¹⁰ Penobscot Community Health Care, Bangor, Maine, USA.
¹¹ Penobscot Community Health Care, Belfast, Maine, USA.
¹² Rural Social Service Solutions, LLC, New Meadows, Idaho, USA.
¹³ St. Mary's Health, Cottonwood, Idaho, USA.
¹⁴ Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA.
¹⁵ Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA.
¹⁶ Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA.
¹⁷ Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
¹⁸ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 37074350
PMCID: PMC10718290
DOI: 10.1111/jrh.12760

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

Yih-Ing Hser et al. J Rural Health. 2023 Sep.

. 2023 Sep;39(4):780-788.

doi: 10.1111/jrh.12760. Epub 2023 Apr 19.

Authors

Affiliations

¹ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA.
² VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
³ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
⁴ RAND Corporation, Santa Monica, California, USA.
⁵ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.
⁶ Data and Statistical Center, the Emmes Company, Rockville, Maryland, USA.
⁷ Department of Biostatistics, University of California, Los Angeles, California, USA.
⁸ Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, California, USA.
⁹ Providence, Colville, Washington, USA.
¹⁰ Penobscot Community Health Care, Bangor, Maine, USA.
¹¹ Penobscot Community Health Care, Belfast, Maine, USA.
¹² Rural Social Service Solutions, LLC, New Meadows, Idaho, USA.
¹³ St. Mary's Health, Cottonwood, Idaho, USA.
¹⁴ Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, Maryland, USA.
¹⁵ Clinical Coordinating Center, Emmes Company, Rockville, Maryland, USA.
¹⁶ Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA.
¹⁷ Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.
¹⁸ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.

PMID: 37074350
PMCID: PMC10718290
DOI: 10.1111/jrh.12760

Abstract

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.

Keywords: care coordination; medication for opioid use disorder; opioid use disorder; primary care; rural community; telemedicine.

PubMed Disclaimer

Conflict of interest statement

Andrew J. Saxon receives royalties as a section editor for UpToDate, received travel support from Alkermes, Inc., and consultant fees from Indivior, Inc. In addition to her academic affiliation, Dr. Lisa A. Marsch is affiliated with HealthSim, LLC, Pear Therapeutics, and Square2 Systems, Inc. Dr. Marsch has worked extensively with her institutions to manage any potential conflict of interest. Dr. Murphy reports having consulted for Sandoz Inc., Nature Sacred Inc., and West Virginia Perinatal Partnership Inc., outside of the submitted work. All other authors report no financial or other possible conflict of interest.

Figures

**FIGURE 1**
Care coordination model between rural primary care and the TM MOUD provider. Abbreviations: MOUD, medication treatment for opioid use disorder; TM, telemedicine.

See this image and copyright information in PMC

References

1. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I, Barnett ML. Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US. JAMA Intern Med. 2021;181(3):388–391. - PMC - PubMed
1. Busch AB, Sugarman DE, Horvitz LE, Greenfield SF. Telemedicine for treating mental health and substance use disorders: reflections since the pandemic. Neuropsychopharmacology. 2021;46(6): 1068–1070. - PMC - PubMed
1. Rubin R Using telemedicine to treat opioid use disorder in rural areas. JAMA. 2019;322(11):1029–1031. - PubMed
1. Hser YI, Mooney LJ. Integrating telemedicine for medication treatment for opioid use disorder in rural primary care: beyond the COVID pandemic. J Rural Health. 2021;37(1):246–248. - PMC - PubMed
1. Blue H, Dahly A, Chhen S, et al. Rural emergency medical service providers perceptions on the causes of and solutions to the opioid crisis: a qualitative assessment. J Prim Care Community Health. 2021;12:1–9. doi:10.1177/2150132720987715 - DOI - PMC - PubMed

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Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

Affiliations

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single-arm, multisite feasibility study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical