OHSU Family Medicine opioid use disorder treatment programs are structured to meet patients where they’re at along the path to recovery.
OHSU Family Medicine researchers Heather Angier, Ph.D., M.P.H., and Steffani Bailey, Ph.D., recently published two papers from a study that shows successes in OHSU’s opioid use disorder programs. In 2016, OHSU Family Medicine implemented an interdisciplinary, tier-based model of care at two of its clinics.
The interdisciplinary, tier-based model of care is based on the premise that opioid use disorder is a relapsing and remitting condition.
An interdisciplinary model is one in which primary care providers (including doctors, nurses, and physician’s assistants), behavioral health providers (such as psychologists and social workers), and registered nurses work together with patients in their primary care home to improve resilience and coping skills, prevent relapses, and manage care. In the previous model, behavioral health services were used on an ad-hoc basis, and provider types other than primary care physicians were not routinely engaged.
The tier-based element places patients in one of five tiers throughout their treatment program, and the tiers help guide frequency of visits and duration between medication fills. Patients can move up or down tiers based on their ability to engage in the program, progress in psychosocial domains, and health outcomes.
The first paper – Tier-based treatment for opioid use disorder in the primary care setting: trajectories and implications in Family, Systems, and Health Journal – examined how patients moved through the tiers. The study found no distinct pattern of movement; yet, most often reductions in tier were the result of difficult psychosocial situations, like housing instability, pain or illness, and family trauma. Conversely, moving up a tier was often accompanied by positive life events, like finding a job, maintaining relationships, and maintaining buprenorphine dosage (a medication used to treat OUD).
“What’s great about this program is that it not only allows patients to remain in treatment during relapse, but increases support during this time. It’s based on the premise that opioid use disorder is a relapsing and remitting condition, so it really meets patients where they are,” says Dr. Angier.
The tier-based model helps providers and patients expect and plan for periods of difficulty throughout treatment. “The finding that patients moved in and out of tiers but remained in treatment reinforces the benefit of not terminating treatment if a patient relapses,” she adds.
The second paper – Associations of retention on buprenorphine for opioid use disorder with patient characteristics and models of care in the primary care setting in the Journal of Substance Abuse Treatment – found that having an interdisciplinary model of care (which included the tier-guided treatment) was associated with increased odds that a patient would remain on buprenorphine for at least six months. Staying on medication for at least six months is important, as patients who do experience fewer overdose and acute care events.
This newer model provides a patient with the opportunity to develop multiple therapeutic relationships with providers, and allows different types of providers to focus on different elements of the patient’s holistic care.
The paper also examined patient characteristics associated with retention on buprenorphine, including gender, age, race/ethnicity, insurance type, clinic location (urban vs. rural), and comorbidities. Having a psychiatric diagnosis (vs. not having one) was the only measured characteristic associated with at least 6 months of buprenorphine orders. Given the high rate of co-occurrence of opioid use disorders and psychiatric disorders, Dr. Bailey and coauthors recommend a more nuanced examination of the relationship between mental health and buprenorphine treatment retention.
“The work highlighted in these papers is unique in that it was collaboration between researchers, clinicians, and learners,” Dr. Bailey says. “The Department of Family Medicine is leading the way with collaborating across mission areas to provide the best care for our patients.”
These projects were funded by the Department of Family Medicine.
Further reading: Dr. Bailey was recently awarded a grant from the National Institute on Drug Abuse (NIDA) to study the use of telehealth for opioid use disorder treatment. Read more about her work here.
