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Impact of an intervention to implement provision of opioid use disorder medication among patients with and without co-occurring substance use disorders.
Frost MC, Malte CA, Hawkins EJ, Glass JE, Hallgren KA, Williams EC. Impact of an intervention to implement provision of opioid use disorder medication among patients with and without co-occurring substance use disorders. Journal of substance use and addiction treatment. 2023 Sep 24; 209175.
Co-occurring substance use disorders (SUDs) are common among people with opioid use disorder (OUD) and known to hinder receipt of medications for OUD (MOUD). How MOUD care implemented outside of SUD specialty settings impacts access for patients with co-occurring SUDs is important to understand. The Veterans Health Administration''s (VA) Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative was implemented in primary care, mental health, and pain clinics in 18 VA facilities, and was found to increase MOUD receipt. This study assessed the SCOUTT initiative''s impact among patients with and without co-occurring SUDs.
This study used a controlled interrupted time series design. The study extracted electronic health record data for patients with OUD with visits in SCOUTT intervention or matched comparison clinics during the postimplementation year (9/1/2018-8/31/2019). We examined the monthly proportion of patients who received MOUD in SCOUTT intervention or comparison clinics (primary care, mental health, and pain clinics), or in a VA SUD specialty clinic (where patients may have been referred), during the pre- and postimplementation years. Segmented logistic regression models estimated pre-post changes in outcomes (immediate level change from the final month of the pre-implementation period to the first month of the post-implementation period, change in trend/slope) in intervention vs. comparison facilities, adjusting for patient characteristics and pre-implementation trends. We stratified analyses by the presence of co-occurring SUDs.
Among patients without co-occurring SUDs, the pre-post trend/slope change in MOUD received in SCOUTT intervention or comparison clinics was greater in intervention vs. comparison facilities (adjusted odds ratio [aOR]: 1.06, 95?% confidence interval [CI]: 1.02-1.10), and the immediate increase in MOUD received in SUD clinics was greater in intervention vs. comparison facilities (aOR: 1.12, 95?% CI: 1.02-1.22). These changes did not significantly differ in intervention vs. comparison facilities among patients with co-occurring SUDs.
The SCOUTT initiative may have increased MOUD receipt primarily among patients without co-occurring SUDs. Focusing on increasing MOUD receipt for patients with co-occurring SUDs may improve the overall effectiveness of MOUD implementation efforts.