Medication-Assisted Treatment in the Hudson Headwaters Health Network

Background: Opioid use results in over 45,000 overdose deaths annually in the US, with rural areas disproportionately affected. While medication-assisted treatment (MAT) for opioid use disorder (OUD) is an effective intervention available through outpatient primary care, less than 25% of patients with OUD are currently in treatment. This study explored factors associated with patient retention in an MAT program offered by Hudson Headwaters, a Federally Qualified Health Center that serves a vast and mostly rural region of Northeastern New York. Methods: We included a total of 354 patients diagnosed with OUD who had at least two appointments for MAT between December 2016 and November 2019 in this analysis. We ran univariate and multivariate regression analyses to examine factors associated with overall retention. Results: The median age at the first MAT visit was 35.2 years (IQR=12.0), and 50% of patients self-identified as female. Overall, the one-year retention rate was 74.7% (95%CI=68.6-81.4). Increased risk for lower retention was seen among men (HR=1.7, 95%CI=1.0-2.8) and those not commercially insured (HR=3.2, 95%CI=1.1-8.7). Receiving MAT directly from a primary care provider greatly reduced the risk of lower retention (HR=0.4 ,95% CI=0.2-1.0). Roundtrip, median travel time to access care was 27.2 minutes (IQR=33.1). Although 12% of patients drove over 60 minutes to get to their MAT clinic, travel time and distance was not associated with retention. Conclusions: While some surveys have suggested that patient access to MAT clinics is a significant barrier to treatment, for this chiefly rural population, ease of access as measured by travel time and distance was less influential on outcomes than other patient- and provider-level factors. Potential recommendations to improve retention include engaging primary care providers in MAT provision and the use of case management services to address other socioeconomic barriers to treatment.https://scholarworks.uvm.edu/fmclerk/1626/thumbnail.jp