(106) Primary Care Addiction Consultation Service: Colorado’s Implementation Support Project

Background & Introduction: While opioid prescribing has slowed over the past decade, drug-related overdose and death are on the rise.1 People with substance use disorders commonly present to primary care practices, and primary care practices are often the first location a patient may seek treatment. Given the rise in use of and overdoses from synthetic opioids, it has become paramount to increase access to treatment for substance use disorders in both urban and rural areas. Addiction medicine consult services have emerged to help address the shortage in access to treatment for substance use disorders.2 This intervention used a primary care office-based opioid treatment program and addiction consultation service model, including education, subject matter expert access, practice facilitation, and financial incentives, to increase capacity for evidence-based OUD treatment.

Methods: Implementation support for medication for opioid use disorder (MOUD) was a 13-month, multicomponent intervention to increase primary care practice capacity to offer MOUD. Fifteen rural and non-rural Colorado primary care practices participated from January 2022 through January 2023. Practices received education, practice facilitation and peer-to-peer consultation support from an addiction medicine physician. To build sustainable services, practice implementation support focused on three core aims: 1) Build your team, 2) Engage and support patients, 3) Connect with recovery support services. Data sources include quarterly checklists measuring milestone progress and monthly semi-structured field notes documenting practice interactions. Practices’ level of implementation of each milestone activity was rated on a four-point scale ranging from 1) Not Started – No work has started on activity at the practice site, to 4) Completed – Activity is fully and regularly implemented at practice site. Financial incentives were offered to participating practices for completion of core aims (maximum $12,000 each), and to practice facilitators for monthly meetings with practices and practices’ completion of core aims (maximum $9,900 per practice).
We used descriptive statistics to summarize practice characteristics, buprenorphine prescribing activity, and milestone completion. We used regression analysis to examine changes over time in prescribing and milestone implementation.

Results: The number of buprenorphine prescriptions written by clinicians in participating practices in the preceding 3 months increased from 2.1 prescriptions at baseline to 11.3 after 13 months of program participation. Implementation of milestones related to medication for opioid use disorder also increased during program participation. Ratings of implementation for core aim 1) Build your team increased from 55% complete at baseline to 95% complete after 12 months of program participation. Ratings of implementation for core aim 2) Engage and support patients increased from 42% complete at baseline to 86% complete after 12 months of program participation. Ratings of implementation for core aim 3) Connect with recovery support services increased from 46% complete at baseline to 93% complete after 12 months of program participation. Final results of regression analyses will be presented.

Conclusion & Discussion: This presentation describes a model for expanding access to medication for opioid use disorder by harnessing practice-specific, tailored practice facilitation and consultative addiction medicine expertise to build capacity in primary care practices. Research has shown that prescriber education is particularly important for MOUD prescribing activity,3 and this presentation describes one model to support clinicians and care teams in obtaining and implementation this education. A particularly unique aspect of this model is access to a subject matter expert consultant, who can connect fellow clinicians with the most relevant resources and information for their local needs and questions. This model is relevant for clinicians and other practitioners who are interested in multicomponent interventions to support substance use disorder treatment.

References: 1. American Medical Association. 2022 Overdose Epidemic Report. 2022; https://www.ama-assn.org/system/files/ama-overdose-epidemic-report.pdf. Accessed October 10, 2023.
2. Jegede O, Muvvala S, Cahill J, Wade R, Jordan A. Integrating Ambulatory Addiction Consultation Service Into a Community Mental Health Center. Journal of Addiction Medicine. 2023;17(2):126-128.
3. Stein BD, Saloner BK, Golan OK, et al. Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment. JAMA Health Forum. 2023;4(5):e231102-e231102.