Critical access medication for opioid use disorder (MOUD) treatment facilities in the continental United States

Medicare Beneficiary Receipt of Methadone by Drive Time to Opioid Treatment Programs

Importance

To combat the ongoing opioid crisis, policy makers and public health officials are developing novel policies to increase the availability of medications for opioid use disorder (OUD). An important question is to what extent geographic availability of opioid treatment programs (OTPs) is associated with treatment receipt. Understanding this association may help with developing additional policies to increase medication for OUD dispensing and improve population health outcomes.

Objective

To quantify trends in dispensing methadone to Medicare beneficiaries based on proximity to an OTP.

Design, Setting, and Participants

This cross-sectional study analyzed 2020 Medicare fee-for-service claims for methadone for beneficiaries with a recent diagnosis of OUD merged with drive times to OTP locations. Medicare beneficiaries enrolled in a Part D prescription plan and diagnosed with OUD in any of the 3 quarters before and during the 2020 quarter of interest were examined.

Exposure

Drive time between the centroid of a beneficiary's zip code and the closest OTP.

Main Outcomes and Measures

Quarterly methadone receipt among Medicare beneficiaries with a recent OUD diagnosis was assessed using logistic regression models.

Results

In 2020, there were 640 706 Medicare beneficiaries with a recent OUD diagnosis (mean [SD] age, 62.5 [13.5] years; 55.6% female; 65.5% residing in an urban locality at the time of diagnosis). Of these beneficiaries, 9.6% lacked an OTP within a 60-minute drive time. The probability of a beneficiary receiving methadone decreased as the drive time from an OTP increased. Specifically, in urban areas, the likelihood of methadone receipt decreased by a relative 54% from a mean of 5.29% (national interval, 4.27%-6.52%) for beneficiaries who lived within a 5-minute drive of an OTP to 2.39% (national interval, 1.92%-2.98%) for those who lived within a 15-minute drive from an OTP. For rural beneficiaries, the likelihood of methadone receipt decreased by a relative 27% from a mean of 3.42% (national interval, 2.73%-4.28%) for a 5-minute drive time to 2.39% (national interval, 1.92%-2.98%) for a 15-minute drive time. Evidence of a threshold effect at a drive time of 20 minutes was observed for methadone receipt, after which the rate slowed and was similar between urban and rural beneficiaries.

Conclusions and Relevance

These findings suggest that the likelihood of methadone receipt may vary based on proximity to OTP facilities. Where OTPs are located may be a contributor to whether an individual receives methadone treatment.

Hospitalists' Attitudes and Experiences With Posthospitalization Care Transitions for Patients With Substance Use Disorders: A Cross-sectional Analysis

BACKGROUND

Medical hospitalizations are relatively common among individuals who have substance use disorders (SUDs) and represent opportunities for patient engagement and treatment. Posthospitalization transitions of care are an important element of providing full-spectrum inpatient SUD care; however, little is known about clinicians' experiences with postdischarge care transitions.

METHODS

We conducted a cross-sectional study surveying hospital-based medical clinicians (ie, "hospitalists") across 2 large health systems in the state of Utah to assess current practices, barriers, facilitators, and perceptions toward posthospitalization care transitions for patients with SUDs. We used Wilcoxon signed-rank tests to identify the most impactful barriers and facilitators among all respondents. We used logistic regression models to explore the influence of hospitalists' attitudes toward providing SUD care on perceived barriers and facilitators.

RESULTS

The survey was distributed to 429 individuals across 15 hospitals. Eighty-two hospitalists responded to the survey (response rate, 21.4%). Most respondents frequently cared for hospitalized patients with SUDs (n = 63, 77%) and prescribed medications for SUDs (n = 44, 56%). Four respondents (5%) felt that patients received adequate support during care transitions. Lack of social support ( P < 0.001) and social factors such as lack of transportation ( P < 0.001) were perceived as the largest barriers to successful care transitions. Conversely, a partnering outpatient clinic/clinician ( P < 0.001) and outpatient-based care coordination ( P < 0.001) were perceived as the strongest facilitators. Respondents' attitudes toward people with SUDs had a modest effect on perceived barriers and facilitators.

CONCLUSIONS

Hospitalists perceived increased outpatient SUD treatment infrastructure and transitional care supports as most important in facilitating posthospitalization care transitions for patients with SUDs.