Buprenorphine Maintenance Treatment Retention Improves Nationally Recommended Preventive Primary Care Screenings when Integrated into Urban Federally Qualified Health Centers

Abstract

Buprenorphine maintenance therapy (BMT) expands treatment access for opioid dependence and can be integrated into primary health-care settings. Treating opioid dependence, however, should ideally improve other aspects of overall health, including preventive services. Therefore, we examined how BMT affects preventive health-care outcomes, specifically nine nationally recommended primary care quality health-care indicators (QHIs), within federally qualified health centers (FQHCs) from an observational cohort study of 266 opioid-dependent patients initiating BMT between 07/01/07 and 11/30/08 within Connecticut's largest FQHC network. Nine nationally recommended preventive QHIs were collected longitudinally from electronic health records, including screening for chronic infections, metabolic conditions, and cancer. A composite QHI score (QHI-S), based on the percentage of eligible QHIs achieved, was categorized as QHI-S ≥80% (recommended) and ≥90% (optimal). The proportion of subjects achieving a composite QHI-S ≥80 and ≥90 % was 57.1 and 28.6%, respectively. Screening was highest for hypertension (91.0%), hepatitis C (80.1%), hepatitis B (76.3%), human immunodeficiency virus (71.4%), and hyperlipidemia (72.9%) and lower for syphilis (49.3%) and cervical (58.5%), breast (44.4%), and colorectal (48.7%) cancer. Achieving QHI-S ≥80% was positively and independently associated with ≥3-month BMT retention (adjusted odds ratio (AOR) = 2.19; 95% confidence interval (CI) = 1.18-4.04) and BMT prescription by primary care providers (PCPs) rather than addiction psychiatric specialists (AOR = 3.38; 95% CI = 1.78-6.37), and negatively with being female (AOR = 0.30; 95% CI = 0.16-0.55). Within primary health-care settings, achieving greater nationally recommended health-care screenings or QHIs was associated with being able to successfully retain patients on buprenorphine longer (3 months or more) and when buprenorphine was prescribed simultaneously by PCPs rather than psychiatric specialists. Decreased preventive screening for opioid-dependent women, however, may require gender-based strategies for achieving health-care parity. When patients can be retained, integrating BMT into urban FQHCs is associated with improved health outcomes including increased multiple preventive health-care screenings.

Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization

“…A prior study of patients with OUD in federally qualified health centers who were initiating buprenorphine treatment found that receiving buprenorphine from a primary care physician rather than a psychiatrist and being retained in buprenorphine treatment were both associated with higher rates of nationally recommended preventive health care screening. 23 These findings emphasize the important role that primary care can play in improving treatment for patients with OUD. While the idea of increased visit frequency may be daunting, team-based care offers an effective and efficient model.…”

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

“…The C&C also received high satisfaction ratings for reducing drug craving (often associated with relapse) and for promoting better family relationships. Though reported satisfaction levels were highest specifically for addiction treatment, the high levels of medical and psychiatric comorbidity suggest the need to integrate more comprehensive services into the C&C in order to optimize health outcomes (Bachireddy et al, 2014; Haddad, Zelenev, & Altice, 2015; Sylla, Bruce, Kamarulzaman, & Altice, 2007). …”

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

“…Because opioid use disorders are chronic and relapsing, long-term retention in OAT is crucial to meet recovery needs to decrease drug use and relapse, and improve social functioning, quality of life, and reduced mortality (Bart, 2012; De Maeyer, van Nieuwenhuizen, Bongers, Broekaert, & Vanderplasschen, 2013; Korthuis, Tozzi, et al, 2011; Nosyk, 2011; Timko, Schultz, Cucciare, Vittorio, & Garrison-Diehn, 2015). OAT retention has also been associated with improvements in addressing primary care (Haddad, Zelenev, & Altice, 2013, 2015) and HIV treatment outcomes (Altice et al, 2011; Korthuis, Fiellin, et al, 2011). …”