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A mixed methods study of provider factors in buprenorphine treatment retention.

Publication ,  Journal Article
Gertner, AK; Clare, HM; Powell, BJ; Gilbert, AR; Jones, HE; Silberman, P; Shea, CM; Domino, ME
Published in: Int J Drug Policy
July 2022

BACKGROUND: Low retention is a persistent challenge in the delivery of buprenorphine treatment for opioid use disorder (OUD). The goal of this study was to identify provider factors that could drive differences in treatment retention while accounting for the contribution of patient characteristics to retention. METHODS: We developed a novel a mixed-methods approach to explore provider factors that could drive retention while accounting for patient characteristics. We used Medicaid claims data from North Carolina in the United States to identify patient characteristics associated with higher retention. We then identified providers who achieved high and low retention rates. We matched high- and low-retention providers on their patients' characteristics. This matching created high- and low-retention provider groups whose patients had similar characteristics. We then interviewed providers while blinded to which belonged in the high- and low-retention groups on aspects of their practice that could affect retention rates, such as treatment criteria, treatment cost, and services offered. RESULTS: Less than half of patients achieved 180-day treatment retention with large differences by race and ethnicity. We did not find evidence that providers who achieved higher retention consistently did so by providing more comprehensive services or selecting for more stable patients. Rather, our findings suggest use of "high-threshold" clinical approaches, such as requiring participation in psychosocial services or strictly limiting dosages, explain differences in retention rates between providers whose patients have similar characteristics. All low-retention providers interviewed used a high-threshold practice compared to half of high-retention providers interviewed. Requiring patients to participate in psychosocial services, which were often paid out-of-pocket, appeared to be especially important in limiting retention. CONCLUSION: Providers who adopt low-threshold approaches to treatment may achiever higher retention rates than those who adopt high-threshold approaches. Addressing cost barriers and systemic racism are likely also necessary for improving buprenorphine treatment retention.

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Published In

Int J Drug Policy

DOI

EISSN

1873-4758

Publication Date

July 2022

Volume

105

Start / End Page

103715

Location

Netherlands

Related Subject Headings

  • United States
  • Substance Abuse
  • Opioid-Related Disorders
  • Opiate Substitution Treatment
  • North Carolina
  • Humans
  • Buprenorphine
  • 4407 Policy and administration
  • 4206 Public health
  • 17 Psychology and Cognitive Sciences
 

Citation

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Gertner, A. K., Clare, H. M., Powell, B. J., Gilbert, A. R., Jones, H. E., Silberman, P., … Domino, M. E. (2022). A mixed methods study of provider factors in buprenorphine treatment retention. Int J Drug Policy, 105, 103715. https://doi.org/10.1016/j.drugpo.2022.103715
Gertner, Alex K., Hannah Margaret Clare, Byron J. Powell, Allison R. Gilbert, Hendree E. Jones, Pam Silberman, Christopher M. Shea, and Marisa Elena Domino. “A mixed methods study of provider factors in buprenorphine treatment retention.Int J Drug Policy 105 (July 2022): 103715. https://doi.org/10.1016/j.drugpo.2022.103715.
Gertner AK, Clare HM, Powell BJ, Gilbert AR, Jones HE, Silberman P, et al. A mixed methods study of provider factors in buprenorphine treatment retention. Int J Drug Policy. 2022 Jul;105:103715.
Gertner, Alex K., et al. “A mixed methods study of provider factors in buprenorphine treatment retention.Int J Drug Policy, vol. 105, July 2022, p. 103715. Pubmed, doi:10.1016/j.drugpo.2022.103715.
Gertner AK, Clare HM, Powell BJ, Gilbert AR, Jones HE, Silberman P, Shea CM, Domino ME. A mixed methods study of provider factors in buprenorphine treatment retention. Int J Drug Policy. 2022 Jul;105:103715.
Journal cover image

Published In

Int J Drug Policy

DOI

EISSN

1873-4758

Publication Date

July 2022

Volume

105

Start / End Page

103715

Location

Netherlands

Related Subject Headings

  • United States
  • Substance Abuse
  • Opioid-Related Disorders
  • Opiate Substitution Treatment
  • North Carolina
  • Humans
  • Buprenorphine
  • 4407 Policy and administration
  • 4206 Public health
  • 17 Psychology and Cognitive Sciences