Go back to Resources

Offering nurse care management for opioid use disorder in primary care: Impact on emergency and hospital utilization in a cluster-randomized implementation trial

Jun-24

Journal Article

Authors:

Bobb, J. F.

Idu, A. E.

Qiu, H.

Yu, O.

Boudreau, D. M.

Wartko, P. D.

Matthews, A. G.

McCormack, J.

Lee, A. K.

Campbell, C. I.

Saxon, A. J.

Liu, D. S.

Altschuler, A.

Samet, J. H.

Northrup, T. F.

Braciszewski, J. M.

Murphy, M. T.

Arnsten, J. H.

Cunningham, C.O.

Horigian, V. E.

Szapocznik, J.

Glass, J. E.

Caldeiro, R. M.

Tsui, J. I.

Burganowski, R. P.

Weinstein, Z. M.

Murphy, S. M.

Hyun, N.

Bradley, K. A.

Volume:
261

Journal:
Drug Alcohol Depend

PMID:
38875880

URL:
https://www.ncbi.nlm.nih.gov/pubmed/38875880

DOI:
10.1016/j.drugalcdep.2024.111350

Keywords:
Cluster-randomized trial Implementation trial Massachusetts Model Office-based addiction treatment Opioid use disorder

Abstract:
<p>BACKGROUND: Patients with opioid use disorder (OUD) have increased emergency and hospital utilization. The PROUD trial showed that implementation of office-based addiction treatment (OBAT) increased OUD medication treatment compared to usual care, but did not decrease acute care utilization in patients with OUD documented pre-randomization (clinicaltrials.gov/study/NCT03407638). This paper reports secondary emergency and hospital utilization outcomes in patients with documented OUD in the PROUD trial. METHODS: This cluster-randomized implementation trial was conducted in 12 clinics from 6 diverse health systems (March 2015-February 2020). Patients who visited trial clinics and had an OUD diagnosis within 3 years pre-randomization were included in primary analyses; secondary analyses added patients with OUD who were new to the clinic or with newly-documented OUD post-randomization. Outcomes included days of emergency care and hospital utilization over 2 years post-randomization. Explanatory outcomes included measures of OUD treatment. Patient-level analyses used mixed-effect regression with clinic-specific random intercepts. RESULTS: Among 1988 patients with documented OUD seen pre-randomization (mean age 49, 53 % female), days of emergency care or hospitalization did not differ between intervention and usual care; OUD treatment also did not differ. In secondary analyses among 1347 patients with OUD post-randomization, there remained no difference in emergency or hospital utilization despite intervention patients receiving 32.2 (95 % CI 4.7, 59.7) more days of OUD treatment relative to usual care. CONCLUSIONS: Implementation of OBAT did not reduce emergency or hospital utilization among patients with OUD, even in the sample with OUD first documented post-randomization in whom the intervention increased treatment.</p>

Go back to Resources