Medication-Assisted Treatment for Substance use Disorders within a National Community Health Center Research Network

Rieckmann, Traci; Muench, John; McBurnie, Mary Ann; Leo, Michael C.; Crawford, Phillip; Ford, Daren; Stubbs, Jennifer; O’Cleirigh, Conall; Mayer, Kenneth H.; Fiscella, Kevin; Wright, Nicole C.; Doe-Simkins, Maya; Cuddeback, Matthew; Salisbury-Afshar, Elizabeth; Nelson, Christine A.

doi:10.1080/08897077.2016.1189477

Cited by 24 publications

(24 citation statements)

References 80 publications

(108 reference statements)

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“…The patients served in community clinical settings or health systems experience a broad range of healthcare environments, social determinants of health, and complex co-morbidities [ 51 ]. The results of research studies in these settings would be more representative of those communities than results of research carried out in academic settings, which tend to be highly selective with respect to patients, providers and healthcare environments [ 49 – 52 ].…”

Section: Discussion- Recommendationsmentioning

confidence: 99%

“… Health Systems: The use of electronic health records (EHRs) has increased significantly during the last two decades. EHRs have the potential to contribute to knowledge regarding patient-level clinical data, including the assessment of continuity of care and comparative effectiveness of treatments; monitoring the impact of new interventions [ 46 ]; eliminating unnecessary, inefficient, or ineffective activities; and addressing population-level questions, such as identification of disparities related to prevalence and treatment of health conditions [ 47 – 52 ]. …”

Section: Hispanic/latino Health Research Landscape and Opportunitiesmentioning

confidence: 99%

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Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

et al. 2017

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Persons of Hispanic/Latino descent may represent different ancestries, ethnic and cultural groups and countries of birth. In the U.S., the Hispanic/Latino population is projected to constitute 29% of the population by 2060. A personalized approach focusing on individual variability in genetics, environment, lifestyle and socioeconomic determinants of health may advance the understanding of some of the major factors contributing to the health disparities experienced by Hispanics/Latinos and other groups in the U.S., thus leading to new strategies that improve health care outcomes. However, there are major gaps in our current knowledge about how personalized medicine can shape health outcomes among Hispanics/Latinos and address the potential factors that may explain the observed differences within this heterogeneous group, and between this group and other U.S. demographic groups. For that purpose, the National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the Food and Drug Administration (FDA), held a workshop in which experts discussed (1) potential approaches to study medical treatments and health outcomes among Hispanics/Latinos and garner the necessary evidence to fill gaps of efficacy, effectiveness and safety of therapies for heart, lung, blood and sleep (HLBS) disorders and conditions--and their risk factors; (2) research opportunities related to personalized medicine to improve knowledge and develop effective interventions to reduce health disparities among Hispanics/Latinos in the U.S.; and (3) the incorporation of expanded sociocultural and socioeconomic data collection and genetic/genomic/epigenetic information of Hispanic/Latino patients into their clinical assessments, to account for individual variability in ancestry; physiology or disease risk; culture; environment; lifestyle; and socioeconomic determinants of health. The experts also provided recommendations on: sources of Hispanic/Latino health data and strategies to enhance its collection; policy; genetics, genomics and epigenetics research; and integrating Hispanic/Latino health research within clinical settings.

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Section: Discussion- Recommendationsmentioning

confidence: 99%

Section: Hispanic/latino Health Research Landscape and Opportunitiesmentioning

confidence: 99%

Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

et al. 2017

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“…11 Buprenorphine is an alternative to methadone that can be used in primary care, 10 is an effective treatment for OUD compared with abstinence-only treatment models, 10,12,13 and is currently underused. 14,15 Limited research has shown disparities in MAT initiation in primary care settings by age, 14,16 race/ethnicity, 16 and health insurance coverage. 14,16 Findings regarding the relationships between MAT initiation and psychiatric and physical comorbidities are mixed and seem to vary depending on the specific comorbidity.…”

mentioning

confidence: 99%

“…14,15 Limited research has shown disparities in MAT initiation in primary care settings by age, 14,16 race/ethnicity, 16 and health insurance coverage. 14,16 Findings regarding the relationships between MAT initiation and psychiatric and physical comorbidities are mixed and seem to vary depending on the specific comorbidity. 14 However, mental and physical health conditions are known to be common in patients with OUD, 17 and patients with mental illness have higher rates of substance use.…”

mentioning

confidence: 99%

“…14,16 Findings regarding the relationships between MAT initiation and psychiatric and physical comorbidities are mixed and seem to vary depending on the specific comorbidity. 14 However, mental and physical health conditions are known to be common in patients with OUD, 17 and patients with mental illness have higher rates of substance use. 18 This strong association between substance use and psychiatric comorbidities 19 can make initiation and maintenance in MAT programs more difficult in this population.…”

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confidence: 99%

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Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

et al. 2019

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Introduction: Medication-assisted treatment (MAT) for opioid use disorder (OUD) is underused in primary care. Little is known about patient demographics associated with MAT initiation, particularly among models with an interdisciplinary approach, including behavioral health integration. We hypothesize few disparities in MAT initiation by patient characteristics after implementing this model for OUD. Methods: Electronic health record data were used to identify adults with ≥1 primary care visit in 1 of 2 study clinics in a Pacific Northwest academic health system between September 1, 2015 and August 31, 2017 (n = 23,372). Rates of documented OUD diagnosis were calculated. Multivariate logistic regression estimated odds ratios of MAT initiation, defined as ≥1 electronic health record order for buprenorphine or naltrexone, by patient covariates. Results: Seven percent of the study sample had an OUD diagnosis. Of those patients, 32% had ≥1 MAT order. Patients with documented psychiatric diagnoses or tobacco use had higher odds of initiating MAT (odds ratio [OR] = 1.62, P = .0003; OR = 2.46, P < .0001, respectively). Uninsured, Medicaid, and Medicare patients had lower odds than those commercially insured (OR = 0.53, 0.38, and 0.31, respectively; P < .0001). Patients who were older, of a race/ethnicity other than non-Hispanic white, had documented diabetes, and had documented asthma or chronic obstructive pulmonary disease showed lower odds of initiation. Discussion: MAT initiation varied by patient characteristics, including disparities by insurance coverage and race/ethnicity. The addition of behavioral health did not eliminate disparities in care, but higher odds of initiation among those with a documented psychiatric diagnosis may suggest this model reaches some vulnerable populations. Additional research is needed to further examine these findings.

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Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership

Croff

Hoffman

Alanis-Hirsch

et al. 2018

J Behav Health Serv Res

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Pharmacotherapy includes a growing number of clinically effective medications for substance use disorder, yet there are significant barriers to its adoption and implementation in routine clinical practice. The Medication Research Partnership (MRP) was a successful effort to promote adoption of pharmacotherapy for opioid and alcohol use disorders in nine substance abuse treatment centers and a commercial health plan. This qualitative analysis of interviews (n = 39) conducted with change leaders at baseline and at the end/beginning of 6-month change cycles explains how treatment centers overcame obstacles to the adoption, implementation, and sustainability of pharmacotherapy. Results show that barriers to adopting, implementing, and sustaining pharmacotherapy can be overcome through incremental testing of organizational change strategies, accompanied by expert coaching and a learning community of like-minded professionals. The greatest challenges lie in overcoming abstinence-only philosophies, establishing a business case for pharmacotherapy, and working with payers and pharmaceutical representatives.

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Medication-Assisted Treatment for Substance use Disorders within a National Community Health Center Research Network

Abstract: These findings suggest that effective opioid and alcohol MAT may be substantially underprescribed among safety-net patients identified as having OUDs or AUDs.

Cited by 24 publications

References 80 publications

Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

Overcoming Barriers to Adopting and Implementing Pharmacotherapy: the Medication Research Partnership

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