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August 15, 2019 (Cleveland)

Opioid Consortium Leverages Research Analysis to Develop Strategies for Expanding Access to MAT

The Northeast Ohio Hospital Opioid Consortium executive committee has approved a set of recommendations aimed at expanding access to MAT, medication-assisted treatment. The recommendations are based on the findings of an analysis conducted by the internal team at The Center for Health Affairs in order to better understand the barriers limiting access to MAT.

One of the goals in the Opioid Consortium’s strategic plan is to increase MAT utilization. In March, the executive committee issued a request to participating hospitals to maintain up-to-date listings of affiliated physicians with MAT waivers and to share this information with care coordinators. In conjunction with these efforts, it is important to understand the barriers associated with MAT experienced by both those prescribers who are providing it and those who are not. Therefore, The Center conducted an analysis of the existing research literature on barriers to prescribing MAT to identify recurring themes.

LITERATURE REVIEW

A number of relevant research studies have been conducted within the past five years. The Center took a close look at those that directly addressed barriers to prescribing MAT, specifically buprenorphine. From there, the research was narrowed to the following four studies published between 2015 and 2018 that include Ohio in their geographic area as well as the various disciplines – physicians, nurse practitioners and physician assistants – who could potentially become waivered providers:

• The Health and Human Services Public Access Study featured work out of the University of Wisconsin and the Ohio Department of Mental Health and Addiction Services, which took a sample of Ohio Specialty Treatment Organizations, with 37 centers responding.
• The Journal of Substance Abuse Treatment published a study from Johns Hopkins University School of Medicine, which concentrated on 1,125 rural providers.
• A study published by the Annals of Family Medicine from the University of Washington School of Medicine, which captured 5,580 urban, suburban and rural providers.
• A study out of University of Michigan’s School of Public Health Behavioral Workforce Research Center focused specifically on 240 nurse practitioners and physician assistants.

RESEARCH FINDINGS

The two predominant themes that arose from the studies were centered on insufficient prescribing capacity, meaning there were not enough physicians prescribing MAT, and insufficient support services, such as behavioral health.

Other recurring themes included:

• Concerns of diversion and misuse of MAT by patients.
• Insufficient reimbursement.
• Insufficient training in opioid use disorders (OUD), including lack of education and mentorship in addiction services.
• Hesitation by providers to obtain waivers for a variety of reasons, including the challenges associated with providing OUD treatment, and objections related to agonist treatment and engaging in MAT.
• Time constraints that limit providers’ availability to treat additional patients.

NEXT STEPS

Based on the findings, the Opioid Consortium executive committee approved a series of recommendations for expanding access to MAT, focusing on insufficient prescribing capacity, insufficient support services such as counseling programs, and educating providers on MAT. Tactics include the following:

• Develop strategies to recruit physicians into addiction treatment practice.
• Target former prescribers with the objective of reactivating their waiver.
• Implement practice-level interventions to encourage resistant practice partners, including providing education on evidence-based practices for OUD.
• Integrate care settings by increasing access to OUD treatment no matter where the patient enters the health system.
• Connect students and providers with MAT mentors. 

The executive committee also determined that training related to reducing stigma associated with OUD is another potential area of focus.

Moving forward, the Opioid Consortium will begin work to develop programming related to implementing these recommendations. 

MORE: For more on the Opioid Consortium’s efforts to expand access to MAT, contact us. 

TWEETABLE: Based on an analysis of existing research, the #OpioidConsortium is tackling barriers to expanding access to MAT for patients with opioid addiction.