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Implementation Outcomes of Low Threshold Care for Persons with Opioid Use Disorders
Wayne Kepner1,2,3, Hannah Cheng4,5, Berkeley Franz6
1Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. wkepner@gmail.com.
Journal of General Internal Medicine
|January 14, 2026
Summary
Low-threshold care (LTC) measures improve access to medication for opioid use disorder (MOUD). Brief LTC scales effectively predicted increases in new MOUD patients, aiding quality improvement in primary care settings.
Area of Science:
- Implementation science
- Addiction medicine
- Primary care research
Background:
- Low-threshold care (LTC) practices enhance access to medication for opioid use disorder (MOUD) by reducing treatment barriers.
- Standardized measures for LTC operationalization are lacking, hindering consistent implementation.
Purpose of the Study:
- To develop and validate composite measures of LTC.
- To assess the utility of these measures in predicting implementation outcomes for MOUD treatment.
Main Methods:
- A prospective cohort study involving 20 safety-net primary care clinics in California.
- Development and testing of four LTC composite scales (LTC12, LTC5, LTC3, LTC2) using Likert items.
- Analysis of implementation outcomes including patient Reach, Retention, and Adoption using repeated-measures ANOVA and Poisson GEE.
Main Results:
- Clinics demonstrated significant improvements in LTC scores over time, with LTC12 showing the largest effect size.
- A 1-point increase in the LTC3 index correlated with a 37% rise in new MOUD patients.
- A 1-point increase in LTC2 was associated with a 24% increase in new MOUD patients.
Conclusions:
- The developed LTC measures show preliminary empirical support for replicability in primary care.
- Longer scales exhibited better internal consistency and sensitivity to change.
- Brief scales effectively predicted patient reach outcomes, offering a tool for quality improvement in MOUD services.
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