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Proactive Tele-Outreach to Increase Adoption of Medications for Opioid Use Disorder in a Large Health Care System
David Lawrence1,2, Pushpa V Raja1,3, Cristian D Yanes4
1Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Background:
Medications for opioid use disorder (MOUD) are shown to improve quality of life while reducing risk for overdose and death among people with OUD. The Veterans Health Administration has supported numerous efforts to increase MOUD availability, but a treatment gap persists: among Veterans with OUD, half do not receive MOUD, and over 5000 died from overdose between 2016 and 2021. To improve MOUD adoption in a large VA health system, we developed a care model to identify and proactively engage Veterans with untreated OUD.
Methods:
The Virtual Outreach Low-Threshold MOUD care initiative (VOLT), a multi-faceted implementation bundle to support MOUD adoption, had 3 core elements: (1) an electronic health record-powered case-finder to identify individuals with untreated OUD and recent OUD-related clinical events (new OUD diagnosis, nonfatal opioid-involved overdose, acute care encounter for OUD, or referral to residential treatment for OUD), (2) case-finder result reconciliation by a physician champion, and (3) proactive tele-outreach to validated cases of untreated OUD by an MOUD prescriber.
Results:
The Case-Finder identified 526 encounters over a 2-year evaluation period. Most were either flagged for an inaccurate OUD diagnosis corrected by the physician champion (163, 31%), or validated as appropriate for tele-outreach (107, 20%). Of tele-outreach cases, 67 (63%) were contacted, and 37 (55%) were deemed MOUD-eligible. Of these, 28 (76%) initiated MOUD, all opting for buprenorphine. Retention on MOUD was 71% at 3 months and 57% at 6 months. The proportion of health system Veterans with OUD receiving MOUD increased from 44% pre- to 54% post-implementation.
Conclusion:
VOLT engaged Veterans with untreated OUD and recent OUD-related clinical events in buprenorphine care with high 3- and 6-month retention and was associated with a 10-percentage point increase in system-wide MOUD adoption. This novel care model may complement existing efforts to close the MOUD treatment gap.
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