Economic analysis of a low-threshold mobile medical unit dispensing buprenorphine for opioid use disorder

The University of Illinois Chicago (UIC) Community Outreach Intervention Projects (COIP) established a low-threshold mobile unit that offers opioid use disorder (OUD) treatment and dispenses buprenorphine on-site in Chicago neighborhoods with high opioid overdose rates. This study aimed to explore patients' perceived facilitators and barriers to accessing and maintaining OUD treatment through the mobile care model.

This qualitative study used brief, semi-structured, one-on-one, post-visit interviews and content analysis to explore patients' perspectives on receiving OUD treatment from a mobile unit that dispenses buprenorphine at point-of-care. The interview guide was informed by a conceptual model categorizing barriers associated with accessing OUD treatment into healthcare-, structural-, and patient-level barriers. A purposive sample of individuals receiving OUD treatment at the mobile unit was recruited and all interviews were conducted on-site in person. At least two independent researchers coded each interview, and conflicts were resolved in discussion. Codes were generated both inductively and deductively (from the conceptual model) through an iterative process and summarized to identify relevant categories and themes using MAXQDA.

A total of 42 individuals were offered participation, and 30 individuals were interviewed. The sample was demographically similar to the general patient population of the UIC mobile unit and had notable variation in substance use history, previous treatment experiences, engagement with the mobile unit, and commute lengths. Among structural factors, a convenient location that was easy to commute to was a mobile unit facilitator. Key healthcare factors that facilitated mobile unit use included welcoming and knowledgeable staff, buprenorphine dispensed on-site, non-OUD services offered, and logistical operations of the mobile unit. The non-stigmatizing environment and adaptable treatment goals were patient factors influencing use of the mobile unit. Limited barriers were identified, but potential barriers included proximity to drug distribution sites and timing of services provided.

We characterize structural, healthcare system, and patient influences in utilization of a mobile unit for OUD treatment. These findings highlight patients' perceptions of a mobile unit for OUD care and validate that the mobile model addressed access barriers. Future research may engage individuals facing barriers that preclude them from presenting to a mobile unit for treatment.