Draft Key Questions
Disposition of Comments Report
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The majority of medication treatment for opioid use disorder (OUD) is provided in primary care settings. Effective and innovative models of care for medication-assisted treatment (MAT) in primary care settings (including rural or other underserved settings) could facilitate implementation and enhance provision and uptake of agonist and antagonist pharmacotherapy in conjunction with psychosocial services for more effective treatment of OUDs.
The purpose of this Technical Brief is to describe promising and innovative MAT models of care in primary care settings, describe barriers to MAT implementation, summarize the evidence available on MAT models of care in primary care settings, identify gaps in the evidence base, and guide future research.
We performed searches in electronic databases from 1995 to mid-June 2016, reviewed reference lists, searched grey literature sources, and interviewed Key Informants. We summarized representative MAT models of care in primary care settings and qualitatively summarized the evidence on MAT models of care in primary care settings and identified areas of future research needs.
We summarized 12 representative MAT models of care in primary care settings, using a framework describing the pharmacological component, the psychosocial services component, the integration/coordination component, and the educational/outreach component. Innovations in MAT models of care include the use of designated nonphysician staff to perform the key integration/coordination role; tiered care models with centralized intake and stabilization of patients with ongoing management in community settings; screening and induction performed in emergency department, inpatient, or prenatal settings with subsequent referral to community settings; community-based stakeholder engagement to develop practice standards and improve quality of care; and use of Internet-based learning networks. Most trials of MAT in primary care settings focus on comparisons of one pharmacological therapy versus another, or on the effectiveness of different intensities or types of psychosocial interventions, rather than on effectiveness of different MAT models of care per se. Key barriers to implementation of MAT models of care include stigma, lack of institutional support, lack of prescribing physicians, lack of expertise, and inadequate reimbursement.
A number of MAT models of care have been developed and implemented in primary care settings. Research is needed to clarify optimal MAT models of care and to understand effective strategies for overcoming barriers to implementation. The models of care presented in this technical brief may help inform the individualized implementation or MAT models of care in different primary care settings.
Korthuis PT, McCarty D, Weimer M, Bougatsos C, et al. Primary Care–Based Models for the Treatment of Opioid Use Disorder: A Scoping Review. Ann Intern Med. [Epub ahead of print 6 December 2016] doi: 10.7326/M16-2149