Evaluation of a Multistage Implementation of Medication for Opioid Use Disorder Services in Primary Care

Despite effective treatment for opioid use disorder, access to care is limited. Increased availability of evidence-based medication for opioid use disorder (MOUD) treatment within primary care is urgently needed. This study describes efforts to increase MOUD services within a large urban primary care practice.

After an internal assessment of barriers to MOUD services, a two-phase approach was used to educate providers and to implement MOUD services within a primary care practice over 2.5 years. Physicians became X-waiver certified in the education phase and completed four internal training sessions. Physicians completed pre-post surveys to assess their intention to prescribe MOUD. In the implementation phase, an interdisciplinary team designed accessible MOUD clinical hours. The RE-AIM model guided the evaluation of the MOUD training and services. The clinic evaluation included a medical records review, a provider focus group (n = 6), and patient interviews (n = 6).

Pre-post surveys indicated that providers did not increase their intentions to prescribe MOUD. Once MOUD clinical hours were operational, the number of providers treating patients with MOUD increased substantially. Patients who received these services found them low-barrier, non-stigmatizing, and effective. The clinical team was satisfied with service delivery but offered suggestions for improvement for the whole primary care team.

Increasing access to MOUD services within primary care may require iterative efforts to overcome practice-specific barriers, and gains may still be moderate. Training in MOUD services should focus on the whole primary care team as it requires interdisciplinary coordination to deliver high-quality services.