Primary care clinics are developing treatment models for opioid use disorder, but few are integrating comprehensive behavioral health strategies to improve outcomes. Although Medication Assisted Treatment (MAT) models that emphasize medications may be effective, 1 failure to offer robust psychosocial services can yield suboptimal outcomes, especially in complex patients.We implemented a behavioral health-focused model for MAT to expand access, better engage patients in treatment, and improve health outcomes. This was built on concepts of harm reduction and improvement in functioning, emphasizing behavioral health counseling in addition to medications.
WHO & WHEREWe created a multidisciplinary team at a rural health clinic and a federally qualified health center in the Pacific Northwest to address the biopsychosocial needs of patients, with the goal of expanding access, improving retention, reducing relapse, and supporting primary care providers in treating addictions. Masters-and doctoral-level mental health clinicians are integrated into the primary care team to address psychosocial needs, teach coping skills and relapse prevention, and build resilience. This is a valuable benefit to improve abstinence over existing models focused on physician-only care.
HOW
Research has examined the safety, efficacy, feasibility, and cost-effectiveness of buprenorphine for the treatment of opioid dependence, but few studies have examined patient and provider experiences, especially in community health centers. Using de-identified electronic health record system (EHRS) data from 70 OCHIN community health centers (n = 1825), this cross-sectional analysis compared the demographics, comorbidities, and service utilization of patients receiving buprenorphine to those not receiving medication-assisted treatment (MAT). Compared to non-MAT patients, buprenorphine patients were younger and less likely to be Hispanic or live in poverty. Buprenorphine patients were less likely to have Medicaid insurance coverage, more likely to self-pay, and have private insurance coverage. Buprenorphine patients were less likely to have problem medical comorbidities or be coprescribed high-risk medications. It is important for providers, clinic administrators, and patients to understand the clinical application of medications for opioid dependence to ensure safe and effective care within safety net clinics.
Introduction
We aimed (1) to demonstrate the application of national pediatric quality measures derived from claims-based data, for use with Electronic Medical Record (EMR) data, and (2) to determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care.
Methods
We reviewed EMR data for all patients up to 15 years with≥1 office visit to a safety net family medicine clinic in 2010 (n=1,544). We assessed rates of appropriate well-child visits (WCVs), immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications.
Results
Among children <3 years, 52.4% attended ≥6 WCVs by 15 months; 60.8% had ≥6 visits by 2 years. Less than 10% completed 10 vaccination series before their 2nd birthday; with modifications, 36% were up-to-date. Among children aged 3-15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year.
Discussion
Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially in populations who may have sporadic patterns of care utilization.
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