TY - JOUR
KW - Buprenorphine/therapeutic use
KW - Humans
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/drug therapy
KW - Primary Health Care
KW - buprenorphine
KW - behavioral health integration
KW - collaborative care model
KW - medications for addiction treatment (MAT)
KW - opioid use disorder
AU - C. D. Brackett
AU - M. Duncan
AU - J. F. Wagner
AU - L. Fineberg
AU - S. Kraft
A1 - 
AB - Background: Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. Treatment in primary care can improve access to treatment and address psychiatric and physical co-morbidities in a holistic, efficient, and non-stigmatizing way. The Collaborative Care Model (CCM) of behavioral health integration into primary care has been widely disseminated and shown to improve outcomes and lower costs when studied for depression, but its use in treating substance use disorders has not been well documented. Methods: We used a mixed-methods approach to examine the impact of implementing multidisciplinary treatment of OUD in our health system's five primary care clinics using the framework of the CCM, with care shared between the primary care clinician (PCP), behavioral health clinician, and medical assistant. The implementation included staff education, creation of electronic health record tools, and implementation support, and was evaluated using data from the electronic health record, the medical staff office, and a clinician survey. Results: Over the last 2 years of implementation, the number of waivered providers increased from 11 to 35, providers prescribing for 5 or more patients increased from 2 to 18, and patients initiated on buprenorphine increased from 4/month to 18/month. 180-day treatment retention was 53%, and 81% of patients had consistently negative urine drug testing. Psychiatric and medical comorbidities were common, 70 and 44%, respectively. Although PCPs who prescribed buprenorphine found working in this model enjoyable and effective, the majority of non-waivered PCPs remained reluctant to participate. Conclusions: In our experience, treatment of OUD in primary care utilizing the CCM effectively addresses OUD and commonly comorbid anxiety and depression, and leads to an expansion of treatment. Successful implementation of OUD treatment requires addressing negative attitudes and perceptions.
AD - Section of General Internal Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Population Health, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA.; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA.; Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Population Health, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Population Health, Dartmouth-Hitchcock, Lebanon, New Hampshire, USA.; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA.
BT - Substance abuse
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 1
CY - United States
DO - 10.1080/08897077.2021.1932698
IS - 1
JF - Substance abuse
LA - eng
M1 - Journal Article
N2 - Background: Treatment of opioid use disorder (OUD) is highly effective, but access is limited and care is often fragmented. Treatment in primary care can improve access to treatment and address psychiatric and physical co-morbidities in a holistic, efficient, and non-stigmatizing way. The Collaborative Care Model (CCM) of behavioral health integration into primary care has been widely disseminated and shown to improve outcomes and lower costs when studied for depression, but its use in treating substance use disorders has not been well documented. Methods: We used a mixed-methods approach to examine the impact of implementing multidisciplinary treatment of OUD in our health system's five primary care clinics using the framework of the CCM, with care shared between the primary care clinician (PCP), behavioral health clinician, and medical assistant. The implementation included staff education, creation of electronic health record tools, and implementation support, and was evaluated using data from the electronic health record, the medical staff office, and a clinician survey. Results: Over the last 2 years of implementation, the number of waivered providers increased from 11 to 35, providers prescribing for 5 or more patients increased from 2 to 18, and patients initiated on buprenorphine increased from 4/month to 18/month. 180-day treatment retention was 53%, and 81% of patients had consistently negative urine drug testing. Psychiatric and medical comorbidities were common, 70 and 44%, respectively. Although PCPs who prescribed buprenorphine found working in this model enjoyable and effective, the majority of non-waivered PCPs remained reluctant to participate. Conclusions: In our experience, treatment of OUD in primary care utilizing the CCM effectively addresses OUD and commonly comorbid anxiety and depression, and leads to an expansion of treatment. Successful implementation of OUD treatment requires addressing negative attitudes and perceptions.
PP - United States
PY - 2022
SN - 1547-0164; 0889-7077
SP - 240
EP - 244
EP - 
T1 - Multidisciplinary treatment of opioid use disorder in primary care using the collaborative care model
T2 - Substance abuse
TI - Multidisciplinary treatment of opioid use disorder in primary care using the collaborative care model
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 34086531
U3 - 10.1080/08897077.2021.1932698
VL - 43
VO - 1547-0164; 0889-7077
Y1 - 2022
ER -