Organization of primary care and early MOUD discontinuation

Rebecca Arden Harris; Matthew Kearney; Shimrit Keddem; Tara Calderbank; Liza Tomczuk; Justin Clapp; Jeanmarie Perrone; Henry R Kranzler; Judith A Long; David S Mandell

doi:10.1186/s13722-024-00527-w

Organization of primary care and early MOUD discontinuation

Addict Sci Clin Pract. 2024 Dec 19;19(1):96. doi: 10.1186/s13722-024-00527-w.

Authors

Rebecca Arden Harris^{1

2}, Matthew Kearney^{3

4}, Shimrit Keddem^{3

4

5}, Tara Calderbank⁶, Liza Tomczuk⁶, Justin Clapp^{4

7

8}, Jeanmarie Perrone^{4

9

10}, Henry R Kranzler^{11

12}, Judith A Long^{4

5

13}, David S Mandell^{4

6

11}

Affiliations

¹ Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. [email protected].
² Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. [email protected].
³ Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Veterans Affairs (VA) Center for Health Equity Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
⁶ Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁸ Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁹ Dept of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia, PA, USA.
¹¹ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹² VISN 4 MIRECC, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
¹³ Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Primary care clinic structures and operations may influence early MOUD discontinuation.
Flexible scheduling can improve early MOUD retention but must be balanced with clinic efficiency.
Multidisciplinary teams can improve retention but require additional resources.
Addressing comorbid pain and polydrug use early in the treatment process can help prevent MOUD discontinuation.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13722-024-00527-w.

Keywords: Buprenorphine; Clinic operations; Early discontinuation; Medications for opioid use disorder (MOUD); Opioid used disorder (OUD); Primary care.

Grants and funding

K23 DA054157/DA/NIDA NIH HHS/United States