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

• Published in: The Journal of rural health Vol. 39; no. 4; pp. 780 - 788
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2023
• Subjects: Access; Clinics; Computerized medical records; Continuity of care; Coordination; Coordination models; COVID-19; COVID-19 - epidemiology; Critical components; Drug abuse; Drug addiction; Drugs; Electronic health records; Electronic medical records; Feasibility; Feasibility Studies; Health care; Health records; Humans; Intervention; Medical records; Medical referrals; Narcotics; Opioid-Related Disorders - drug therapy; Opioids; Pandemics; Patients; Primary care; Primary Health Care; Referrals; Substance use disorder; Telemedicine; opioid use disorder; telemedicine; medication for opioid use disorder; primary care; care coordination; rural community
• ISSN: 0890-765X; 1748-0361; 1748-0361
• DOI: 10.1111/jrh.12760

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. 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. 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. 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.