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Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
Technical Briefs, No. 28
Investigators: Roger Chou, MD, P Todd Korthuis, MD, MPH, Melissa Weimer, DO, MCR, Christina Bougatsos, MPH, Ian Blazina, MPH, Bernadette Zakher, MBBS, Sara Grusing, BS, Beth Devine, PhD, PharmD, MBA, and Dennis McCarty, PhD.
Author Information and AffiliationsStructured Abstract
Background:
The majority of medication treatment for opioid use disorder (OUD) is provided in primary care settings. Effective and innovative models of care for medication-assisted treatment (MAT) in primary care settings (including rural or other underserved settings) could facilitate implementation and enhance provision and uptake of agonist and antagonist pharmacotherapy in conjunction with psychosocial services for more effective treatment of OUDs.
Purpose:
The purpose of this Technical Brief is to describe promising and innovative MAT models of care in primary care settings, describe barriers to MAT implementation, summarize the evidence available on MAT models of care in primary care settings, identify gaps in the evidence base, and guide future research.
Methods:
We performed searches in electronic databases from 1995 to mid-June 2016, reviewed reference lists, searched grey literature sources, and interviewed Key Informants. We summarized representative MAT models of care in primary care settings and qualitatively summarized the evidence on MAT models of care in primary care settings and identified areas of future research needs.
Findings:
We summarized 12 representative MAT models of care in primary care settings, using a framework describing the pharmacological component, the psychosocial services component, the integration/coordination component, and the educational/outreach component. Innovations in MAT models of care include the use of designated nonphysician staff to perform the key integration/coordination role; tiered care models with centralized intake and stabilization of patients with ongoing management in community settings; screening and induction performed in emergency department, inpatient, or prenatal settings with subsequent referral to community settings; community-based stakeholder engagement to develop practice standards and improve quality of care; and use of Internet-based learning networks. Most trials of MAT in primary care settings focus on comparisons of one pharmacological therapy versus another, or on the effectiveness of different intensities or types of psychosocial interventions, rather than on effectiveness of different MAT models of care per se. Key barriers to implementation of MAT models of care include stigma, lack of institutional support, lack of prescribing physicians, lack of expertise, and inadequate reimbursement.
Conclusions:
A number of MAT models of care have been developed and implemented in primary care settings. Research is needed to clarify optimal MAT models of care and to understand effective strategies for overcoming barriers to implementation. The models of care presented in this technical brief may help inform the individualized implementation or MAT models of care in different primary care settings.
Contents
- Preface
- Key Informants
- Peer Reviewers
- Background
- Methods
- Findings
- Summary and Implications
- References
- Appendixes
- Appendix A. Sample Questions for Key Informants
- Appendix B. Search Strategies for Guiding Question 3
- Appendix C. Literature Flow Diagram for Guiding Question 3
- Appendix D. Included Studies List
- Appendix E. Excluded Studies List
- Appendix F. Details of Trials for Guiding Question 3
- Appendix G. Details of Cochrane Systematic Reviews for Guiding Question 3
Suggested citation:
Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I, Zakher B, Grusing S, Devine B, McCarty D. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Technical Brief No. 28. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No. 16(17)-EHC039-EF. Rockville, MD: Agency for Healthcare Research and Quality. December 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied.
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