TY - JOUR
KW - Adolescent
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Female
KW - Health Care Costs
KW - Hospitalization/economics
KW - Humans
KW - Male
KW - Maryland
KW - Medication Adherence
KW - Middle Aged
KW - Opiate Substitution Treatment/economics
KW - Opioid-Related Disorders/drug therapy
KW - Primary Health Care
KW - Young Adult
KW - buprenorphine treatment
KW - Cost
KW - primary care
KW - treatment retention
AU - Y. J. Hsu
AU - J. A. Marsteller
AU - S. G. Kachur
AU - M. I. Fingerhood
A1 - 
AB - Opioid use disorder (OUD) is a national crisis. Health care must achieve greater success than it has to date in helping opioid users achieve recovery. Integration of comprehensive primary care with treatment for OUD has the potential to increase care access among the substance-using population, improve outcomes, and reduce costs. However, little is known about the effectiveness of such care models. The Comprehensive Care Practice (CCP), a primary care practice located in Maryland, implemented a care model that blends buprenorphine treatment for OUD with attention to primary care needs. This study evaluates the model by comparing patients with OUD treated in CCP and other Maryland facilities in a large state Medicaid program. Compared to the non-CCP patient group (n = 867), the CCP group (n = 131) had a higher 6-month buprenorphine treatment retention rate (79% vs. 61%, adjusted average marginal effect (AME) = 0.17, P < 0.001). CCP patients also had fewer hospital stays in the 12-month follow-up period (0.22 vs. 0.41, AME = -0.17, P = 0.005), and lower total cost (US$10,942 vs. $13,097, AME = -$4554, P < 0.001) and hospital stay cost (US$1448 vs. $4265, AME = -$2609, P = 0.001), but higher buprenorphine pharmacy cost (US$3867 vs. $2781, AME = $987, P < 0.001). Other measures, including emergency department utilization and cost, substance abuse cost, and non-buprenorphine pharmacy cost, were not statistically different between the 2 groups. Results suggested that patients, as well as the health care system, can benefit from an integrated model of buprenorphine treatment and primary care for OUD with better treatment retention, fewer hospital stays, and lower costs.
AD - 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; 2Johns Hopkins HealthCare, Glen Burnie, Maryland.; 3Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.; 4Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
BT - Population health management
C5 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
CP - 4
CY - United States
DO - 10.1089/pop.2018.0163
IS - 4
JF - Population health management
LA - eng
M1 - Journal Article
N2 - Opioid use disorder (OUD) is a national crisis. Health care must achieve greater success than it has to date in helping opioid users achieve recovery. Integration of comprehensive primary care with treatment for OUD has the potential to increase care access among the substance-using population, improve outcomes, and reduce costs. However, little is known about the effectiveness of such care models. The Comprehensive Care Practice (CCP), a primary care practice located in Maryland, implemented a care model that blends buprenorphine treatment for OUD with attention to primary care needs. This study evaluates the model by comparing patients with OUD treated in CCP and other Maryland facilities in a large state Medicaid program. Compared to the non-CCP patient group (n = 867), the CCP group (n = 131) had a higher 6-month buprenorphine treatment retention rate (79% vs. 61%, adjusted average marginal effect (AME) = 0.17, P < 0.001). CCP patients also had fewer hospital stays in the 12-month follow-up period (0.22 vs. 0.41, AME = -0.17, P = 0.005), and lower total cost (US$10,942 vs. $13,097, AME = -$4554, P < 0.001) and hospital stay cost (US$1448 vs. $4265, AME = -$2609, P = 0.001), but higher buprenorphine pharmacy cost (US$3867 vs. $2781, AME = $987, P < 0.001). Other measures, including emergency department utilization and cost, substance abuse cost, and non-buprenorphine pharmacy cost, were not statistically different between the 2 groups. Results suggested that patients, as well as the health care system, can benefit from an integrated model of buprenorphine treatment and primary care for OUD with better treatment retention, fewer hospital stays, and lower costs.
PP - United States
PY - 2019
SN - 1942-7905; 1942-7891
SP - 292
EP - 299
EP - 
T1 - Integration of Buprenorphine Treatment with Primary Care: Comparative Effectiveness on Retention, Utilization, and Cost
T2 - Population health management
TI - Integration of Buprenorphine Treatment with Primary Care: Comparative Effectiveness on Retention, Utilization, and Cost
U1 - Education & Workforce; Financing & Sustainability; Opioids & Substance Use
U2 - 30543495
U3 - 10.1089/pop.2018.0163
VL - 22
VO - 1942-7905; 1942-7891
Y1 - 2019
Y2 - Aug
ER -