The opioid abuse epidemic has grown rapidly and disproportionately across the US in recent years. Pennsylvania (PA) has been greatly affected by the epidemic; hospitalizations for prescription opioid and heroin overdoses increased by 285 and 315%, respectively, in PA rural counties between 2000 and 2014, compared to 208 and 143% in urban counties. The prevalence of opioid use disorders (OUD) among the Medicaid population has increased in all PA counties except for Philadelphia; however, the health system in rural PA has lacked the capacity to address this need. The typical rural county targeted by this intervention has only one primary care provider who prescribes buprenorphine. The objective of this project is to double the number of primary care physicians delivering high-quality medication-assisted treatment (MAT) in rural PA by implementing and testing a state-led, multi-faceted intervention. Led by the PA Department of Human Services (DHS), the three aims of this project are to 1) Implement solutions to overcoming barriers to implementation of MAT in primary care; 2) Evaluate the effect of the multi-faceted intervention to expand MAT in rural primary care practices on supply of MAT providers and access to high-quality MAT for Medicaid beneficiaries with OUD; and 3) Disseminate findings to state and national stakeholders, and adopt successful program strategies as evidence-based policies in PA Medicaid. Participating practices will be trained to provide MAT consistent with current American Society of Addiction Medicine guidelines. Five intervention components will be available to all primary care practices recruited to participate. 1) An Implementation Team, including MAT and primary care practice management experts, who will assist providers in adding MAT services to their practice; 2) A Training Remote Infusion of MAT program, where practices will remotely join presentations by addiction experts to review complex opioid case studies to improve their own treatment capabilities; 3) A Peer-to-Peer Tele- consultation that participating providers can use to speak with an on-call addiction specialist who will offer insight and expert advice on complex patients and MAT; 4) A Substance Use Disorder (SUD) Health Home hub that will provide care management services for participating practices; and 5) Tele-psychiatry Coordination, where the SUD Health Home care management team will coordinate tele-psychiatry services for patients of participating practices. The intervention will be evaluated using a mixed-methods approach including qualitative, survey, and claims-based analyses. Qualitative data from participating physicians and staff will be continually collected.
Cl aims -based measures will include supply, prevalence, utilization, and outcome variables that will be compared to PA counties that did not receive the intervention using interrupted time series and difference-in-difference analyses. Finally, a Medicaid beneficiary patient survey will measure changes in perceived access to and experience with MAT. DHS will disseminate program materials and will implement successful strategies from the project into evidence-based policies.
This project seeks to implement and test a state-led, multi-faceted intervention aimed towards increasing access to medication-assisted treatment provided by primary care practices for Medicaid beneficiaries in rural Pennsylvania. Results from this project will inform providers and policymakers of successful strategies to support medication-assisted treatment in primary care for a vulnerable population in rural areas affected by the opioid epidemic.
