TY - JOUR
KW - Ambulatory Care
KW - Appointments and Schedules
KW - Buprenorphine/therapeutic use
KW - Health Expenditures
KW - Health Services Accessibility
KW - Heroin Dependence/drug therapy/mortality
KW - Humans
KW - Medicaid/economics
KW - Medical Audit
KW - Medically Uninsured
KW - Narcotic Antagonists/therapeutic use
KW - office visits
KW - Time-to-Treatment
KW - United States/epidemiology
AU - T. Beetham
AU - B. Saloner
AU - S. E. Wakeman
AU - M. Gaye
AU - M. L. Barnett
A1 - 
AB - BACKGROUND: Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment. OBJECTIVE: To assess real-world access to buprenorphine treatment for uninsured or Medicaid-covered patients reporting current heroin use. DESIGN: Audit survey ("secret shopper" study). SETTING: 6 U.S. jurisdictions with a high burden of opioid-related mortality (Massachusetts, Maryland, New Hampshire, West Virginia, Ohio, and the District of Columbia). PARTICIPANTS: From July to November 2018, callers contacted 546 publicly listed buprenorphine prescribers twice, posing as uninsured or Medicaid-covered patients seeking buprenorphine treatment. MEASUREMENTS: Rates of new appointments offered, whether buprenorphine prescription was possible at the first visit, and wait times. RESULTS: Among 1092 contacts with 546 clinicians, schedulers were reached for 849 calls (78% response rate). Clinicians offered new appointments to 54% of Medicaid contacts and 62% of uninsured-self-pay contacts, whereas 27% of Medicaid and 41% of uninsured-self-pay contacts were offered an appointment with the possibility of buprenorphine prescription at the first visit. The median wait time to the first appointment was 6 days (interquartile range [IQR], 2 to 10 days) for Medicaid contacts and 5 days (IQR, 1 to 9 days) for uninsured-self-pay contacts. These wait times were similar regardless of clinician type or payer status. The median wait time from first contact to possible buprenorphine induction was 8 days (IQR, 4 to 15 days) for Medicaid and 7 days (IQR, 3 to 14 days) for uninsured-self-pay contacts. LIMITATION: The survey sample included only publicly listed buprenorphine prescribers. CONCLUSION: Many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to callers reporting active heroin use, particularly those with Medicaid coverage. Nevertheless, wait times were not long, implying that opportunities may exist to increase access by using the existing prescriber workforce.
AD - Harvard T.H. Chan School of Public Health, Boston, Massachusetts (T.B.).; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (B.S.).; Massachusetts General Hospital, Boston, Massachusetts (S.E.W.).; Brigham and Women's Hospital, Boston, Massachusetts (M.G.).; Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts (M.L.B.).
BT - Annals of Internal Medicine
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
CP - 1
DO - 10.7326/M18-3457
IS - 1
JF - Annals of Internal Medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment. OBJECTIVE: To assess real-world access to buprenorphine treatment for uninsured or Medicaid-covered patients reporting current heroin use. DESIGN: Audit survey ("secret shopper" study). SETTING: 6 U.S. jurisdictions with a high burden of opioid-related mortality (Massachusetts, Maryland, New Hampshire, West Virginia, Ohio, and the District of Columbia). PARTICIPANTS: From July to November 2018, callers contacted 546 publicly listed buprenorphine prescribers twice, posing as uninsured or Medicaid-covered patients seeking buprenorphine treatment. MEASUREMENTS: Rates of new appointments offered, whether buprenorphine prescription was possible at the first visit, and wait times. RESULTS: Among 1092 contacts with 546 clinicians, schedulers were reached for 849 calls (78% response rate). Clinicians offered new appointments to 54% of Medicaid contacts and 62% of uninsured-self-pay contacts, whereas 27% of Medicaid and 41% of uninsured-self-pay contacts were offered an appointment with the possibility of buprenorphine prescription at the first visit. The median wait time to the first appointment was 6 days (interquartile range [IQR], 2 to 10 days) for Medicaid contacts and 5 days (IQR, 1 to 9 days) for uninsured-self-pay contacts. These wait times were similar regardless of clinician type or payer status. The median wait time from first contact to possible buprenorphine induction was 8 days (IQR, 4 to 15 days) for Medicaid and 7 days (IQR, 3 to 14 days) for uninsured-self-pay contacts. LIMITATION: The survey sample included only publicly listed buprenorphine prescribers. CONCLUSION: Many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to callers reporting active heroin use, particularly those with Medicaid coverage. Nevertheless, wait times were not long, implying that opportunities may exist to increase access by using the existing prescriber workforce.
PY - 2019
SN - 1539-3704; 0003-4819; 0003-4819
SP - 1
EP - 9
EP - 
T1 - Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality: An Audit Study
T2 - Annals of Internal Medicine
TI - Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality: An Audit Study
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
U2 - 31158849
U3 - 10.7326/M18-3457
VL - 171
VO - 1539-3704; 0003-4819; 0003-4819
Y1 - 2019
Y2 - Jul 2
ER -