Patients engaged in care for OUD more likely to continue care up to 24 months
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The likelihood of retention over 6, 12 and 24 months was significantly higher for patients engaged in care for opioid use disorder, compared with those who were not, per a study published in the American Journal of Psychiatry.
“There are serious unmet needs to better understand the processes of care initiation, engagement, and retention so that interventions can be better tailored to improve clinical outcomes,” Stephen Crystal, PhD, of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University in New Brunswick, New Jersey, and co-author of the study, told Healio. “We found that the first month in care is critical for successfully stabilizing patients, otherwise they disappear.”
Crystal and fellow researchers sought to investigate the predictive value of early treatment response on 6-month treatment retention for those with opioid use disorder and to evaluate whether successful treatment engagement was associated with longer durations of care.
They analyzed data from electronic health records of a multisite buprenorphine clinic network across eight states from January 2011 through April 2019, to include 19,487 individuals (average age, 35.7 years, 57.5% male). Patients were stratified into risk categories based on treatment response (ie, opioid-free urine drug screen) to determine the number of visits per month, with visits typically conducted weekly or twice weekly in the first month of care. Care episodes were limited to patients completing their intake visit who had not received care at any partner site in the preceding 90-day period to identify new care episodes for OUD.
Primary analysis investigated probability of treatment discontinuation during the 180-day period following admission based on engagement status. Treatment discontinuation was defined as a gap of 60 or more days in visits and attributed the last day in care to the final clinic visit date. Absolute percentage differences in likelihood of successful retention were calculated, as well as adjusted odds ratios using logistic regression based on engagement status that adjusted for age, sex, and other baseline patient characteristics. Retention analyses were repeated for 12 and 24 months as secondary outcomes.
Results showed that 16,063 (82.4%) patients successfully engaged in care, and 3,424 (17.6%) did not. Among those successfully engaged, 47% remained in care for a minimum of 6 months compared with 2.9% of those who did not meet measurement criteria for initial treatment engagement. The relationship between engagement and successful retention persisted but was attenuated for longer periods of retention at 12 months and 24 months (31.8% vs. 1.5%; 20.8% vs. 0.01%, respectively).
Researchers additionally found those who engaged compared with those who did not engage had 20.7 times (95% CI = 16.8, 25.5) the odds of 6-month retention, and while the relationship persisted it was attenuated for longer periods of retention. Odds of 6-month retention were also increased for women (adjusted OR = 1.32, 95% CI, 1.23–1.41), adults aged 50 to 64 years compared with those aged 30 years and younger (aOR = 2.02, 95% CI, 1.80–2.26) and those first testing positive for buprenorphine (aOR = 1.88, 95% CI, 1.75–2.01) compared with their respective reference groups.
“Care pathways need to be tailored to individual patients. Arthur R. Williams, MD, MBE, of the department of psychiatry at New York State Psychiatric Institute, Columbia University Medical Center and co-author of the study, told Healio. “But the field has been slow to recognize this need for the treatment of OUD.”