Three-year Retention Rates With Office-based Treatment of Buprenorphine for Opioid Use Disorder in a Private Family Medicine Practice

Abstract

Objective: Although primary care settings have benefits for implementing office-based opioid treatment (OBOT) programs with buprenorphine, few studies have examined the impact on patient retention beyond 12 months. The objective of this study is to assess long-term outcomes of buprenorphine treatment for opioid use disorder (OUD) integrated into comprehensive primary care treatment at a family medicine practice. Methods: A retrospective chart review of patients diagnosed with OUD who received treatment with buprenorphine between December 2006 and January 2018 was conducted at private family medicine practice in semirural Upstate New York. Patients were seen continuously by the same provider. The primary outcome was retention in OBOT at 3 years. Results: The primary outcome was met by 47.4% of included patients (N = 152). Mean retention in care for all patients was 24.3 months. More than three quarters of patients (77%) had a least one psychiatric comorbidity managed by the practice, most commonly depression (59.9%). Self-reported history of intravenous drug use at baseline was associated with a higher likelihood of patient dropout at year 1 (odds ratio, 2.99; 95% confidence interval, 1.39-6.44; P = 0.004) and year 2 (odds ratio, 2.46; 95% confidence interval, 1.15-5.28; P = 0.019), with no difference observed at year 3. Conclusions: Office-based opioid treatment with buprenorphine in a family medicine practice setting resulted in high retention rates, emphasizing the importance of continuity of care and integration of primary care within the OUD treatment model. Further research is needed on barriers to implementation of OBOT among family medicine providers.

Patient navigation for pregnant individuals with opioid use disorder: Results of a randomized multi‐site pilot trial

“…MOUD engagement has been noted to have significant benefits in reducing adverse outcomes during pregnancy-including preterm birth and overdose events [64][65][66][67][68]-and is an important quality metric of substance use services provided in health-care settings [68,69]. Prior research has sought to identify characteristics associated with MOUD utilization [69][70][71][72][73]; however, these have often identified patient-level characteristics predictive of MOUD use that are not modifiable (e.g. socio-demographic characteristics) with limited recommendations, tools or methods/targets for behavior change [69][70][71][72][73].…”

“…Prior research has sought to identify characteristics associated with MOUD utilization [69][70][71][72][73]; however, these have often identified patient-level characteristics predictive of MOUD use that are not modifiable (e.g. socio-demographic characteristics) with limited recommendations, tools or methods/targets for behavior change [69][70][71][72][73]. The PN intervention delivered to pregnant individuals with OUD in this study is a potential method to promote MOUD engagement as well as SUD treatment attendance.…”

Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care

“…Studies in this setting have yielded less consistent findings for race, sex, and SUD and medical comorbidity. [16][17][18][19][20][21] Identifying disparities in health care receipt and retention is essential to understanding their mechanisms and informing strategies to address them. As the SCOUTT initiative is ongoing, disparities identified from this evaluation can be used to tailor and inform the spread of this VHA initiative.…”

“…Although several studies have examined retention on buprenorphine for treatment of OUD in primary care, few findings have been replicated. Of the factors studied, drug use and younger age have been associated with lower buprenorphine retention 16,17,19,20 and psychiatric comorbidity 20,21 with higher buprenorphine retention among primary care patients. Studies in this setting have yielded less consistent findings for race, sex, and SUD and medical comorbidity 16-21 …”