Role of the National Health Service Corps in Delivering Substance Use Disorder Treatment in Underserved Communities

Rowan, Kathleen; Knudson, Alana; Anderson, Britta L.; Satorius, Jennifer; Shah, Savyasachi; Stahl, Anne; Kepley, Hayden O.

doi:10.1176/appi.ps.20220244

Cited by 6 publications

(9 citation statements)

References 32 publications

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“…In this cross-sectional study, which is part of the larger evaluation, 13 the analytic population consisted of new NHSC clinicians (new LRP awardees in FY 2019 through FY 2021) and all NHSC sites (FY 2019 through FY 2021). All new clinicians and sites were eligible to participate in the evaluation surveys.…”

Section: Methodsmentioning

confidence: 99%

“…In this cross-sectional study, which is part of the larger evaluation, 13 We used clinicians' National Provider Identifiers (NPIs), available from the NHSC application data obtained from HRSA, to identify them in claims data in the preexpansion and postexpansion periods. Assignment to the standard or expansion groups in these analyses was determined by which 1 of the 3 programs NHSC clinicians selected on their applications.…”

Section: Study Populationmentioning

confidence: 99%

“…Prior work, 13 conducted as part of an independent evaluation of HRSA’s SUD investments, described the role of the NHSC in expanding behavioral health services in socially vulnerable and rural areas but did not address the expansion of buprenorphine for treatment of OUD or challenges clinicians faced in providing OUD treatment. This prior analysis, conducted with fiscal year (FY) 2019 NHSC clinicians (the first year of the expansion programs), showed that the percentage of NHSC clinicians working in rural areas increased by 59% between FY 2017 and FY 2020.…”

Section: Introductionmentioning

confidence: 99%

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Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Rowan,

Shah,

Binns

et al. 2024

JAMA Netw Open

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ImportanceThe National Health Service Corps (NHSC) Loan Repayment Program (LRP) expansion in fiscal year (FY) 2019 intended to improve access to medication for opioid use disorder (MOUD) by adding more clinicians who could prescribe buprenorphine. However, some clinicians still face barriers to prescribing, which may vary between rural and nonrural areas.ObjectiveTo examine the growth in buprenorphine prescribing by NHSC clinicians for Medicaid beneficiaries during the NHSC LRP expansion and describe the challenges to prescribing that persist in rural and nonrural areas.Design, Setting, and ParticipantsThis cross-sectional study analyzed preexpansion and postexpansion Medicaid claims data to evaluate the percentage of prescriptions of buprenorphine filled during FY 2017 through 2021. This study also analyzed challenges and barriers to prescribing MOUD between rural and urban areas, using results from annual surveys conducted with NHSC clinicians and sites from FY 2019 through FY 2021.ExposurePrescribing of buprenorphine by NHSC clinicians.Main Outcomes and MeasuresThe main outcomes were the percentage and number of Medicaid beneficiaries with opioid use disorder (OUD) who filled a prescription for buprenorphine before and after the LRP expansion and the challenges NHSC clinicians and sites faced in providing substance use disorder and OUD services. Survey results were analyzed using descriptive statistics.ResultsDuring FYs 2017 through 2021, 7828 NHSC clinicians prescribed buprenorphine (standard LRP: mean [SD] age, 38.1 [8.4] years and 4807 females [78.9%]; expansion LRPs: mean [SD] age, 39.4 [8.1] years and 1307 females [75.0%]). A total of 3297 NHSC clinicians and 4732 NHSC sites responded to at least 1 survey question to the 3 surveys. The overall percentage of Medicaid beneficiaries with OUD who filled a prescription for buprenorphine during the first 2.5 years post expansion increased significantly from 18.9% before to 43.7% after expansion (an increase of 123 422 beneficiaries; P &lt; .001). The percentage more than doubled among beneficiaries living in areas with a high Social Vulnerability Index score (from 17.0% to 36.7%; an increase of 31 964) and among beneficiaries living in rural areas (from 20.8% to 55.7%; an increase of 45 523). However, 773 of 2140 clinicians (36.1%; 95% CI, 33.6%-38.6%) reported a lack of mental health services to complement medication for OUD treatment, and 290 of 1032 clinicians (28.1%; 95% CI, 24.7%-31.7%) reported that they did not prescribe buprenorphine due to a lack of supervision, mentorship, or peer consultation.Conclusions and RelevanceThese findings suggest that although the X-waiver requirement has been removed and Substance Abuse and Mental Health Services Administration guidelines encourage all eligible clinicians to screen and offer patients with OUD buprenorphine, as permissible by state law, more trained health care workers and improved care coordination for counseling and referral services are needed to support comprehensive OUD treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Rowan,

Shah,

Binns

et al. 2024

JAMA Netw Open

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“…More than 106 000 people in the US died from a drug overdose in 2021, largely as a result of synthetic opioid use during the COVID-19 pandemic . This figure indicates a continued burden of substance use but also masks a disproportionate impact on underserved communities, where rates of overdose are increasing rapidly . The harms of substance use disorders (SUDs), including opioid use disorder (OUD), extend far beyond overdose, leading to stress in the health care system amid worsening health disparities …”

Section: Introductionmentioning

confidence: 99%

“… 2 , 3 The harms of substance use disorders (SUDs), including opioid use disorder (OUD), extend far beyond overdose, leading to stress in the health care system amid worsening health disparities. 3 , 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

Substance Use Disorder Program Availability in Safety-Net and Non–Safety-Net Hospitals in the US

Chang,

Franz,

Pagán

et al. 2023

JAMA Netw Open

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ImportanceSafety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown.ObjectiveTo examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership.Design, Setting, and ParticipantsThis cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. Data analysis was performed from January to March 2022.Main Outcomes and MeasuresThis study used 2 survey questions from the American Hospital Association survey to determine the delivery of 5 hospital-based SUD services: screening, consultation, inpatient treatment services, outpatient treatment services, and medications for opioid use disorder (MOUD).ResultsA total of 2846 hospitals were included: 409 were SNHs and 2437 were non-SNHs. The lowest proportion of hospitals reported offering inpatient treatment services (791 hospitals [27%]), followed by MOUD (1055 hospitals [37%]), and outpatient treatment services (1087 hospitals [38%]). The majority of hospitals reported offering consultation (1704 hospitals [60%]) and screening (2240 hospitals [79%]). In multivariable models, SNHs were significantly less likely to offer SUD services across all 5 categories of services (screening odds ratio [OR], 0.62 [95% CI, 0.48-0.76]; consultation OR, 0.62 [95% CI, 0.47-0.83]; inpatient services OR, 0.73 [95% CI, 0.55-0.97]; outpatient services OR, 0.76 [95% CI, 0.59-0.99]; MOUD OR, 0.6 [95% CI, 0.46-0.78]). With the exception of MOUD, public or for-profit SNHs did not differ significantly from their non-SNH counterparts. However, nonprofit SNHs were significantly less likely to offer all 5 SUD services compared with their non-SNH counterparts (screening OR, 0.52 [95% CI, 0.41-0.66]; consultation OR, 0.56 [95% CI, 0.44-0.73]; inpatient services OR, 0.45 [95% CI, 0.33-0.61]; outpatient services OR, 0.58 [95% CI, 0.44-0.76]; MOUD OR, 0.61 [95% CI, 0.46-0.79]).Conclusions and RelevanceIn this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.

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Behavioral Health Workforce Distribution in Socially Disadvantaged Communities

Lombardi,

de Saxe Zerden,

Jensen

et al. 2024

J Behav Health Serv Res

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Role of the National Health Service Corps in Delivering Substance Use Disorder Treatment in Underserved Communities

Cited by 6 publications

References 32 publications

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Substance Use Disorder Program Availability in Safety-Net and Non–Safety-Net Hospitals in the US

Behavioral Health Workforce Distribution in Socially Disadvantaged Communities

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