Development and Validation of the MOUD Access Policy Implementation Index (MAPI2) Measuring Implementation of Policies Supportive of Increased Access to MOUD by Arizona MOUD Providers

Abstract

Abstract Background: U.S. federal regulations allowed treatment accommodations during the COVID-19 pandemic to assure access to medication for opioid use disorder (MOUD). Objective: To develop and validate a MOUD Access Policy Implementation Index (MAPI2) measuring the extent to which providers implement allowed MOUD accommodations. Methods: Responses from a survey of 74 Arizona MOUD providers from September 2021-April 2022 measuring reported adoption of 10 accommodations were used to assess instrument validity. Implementation was measured for three time periods: before COVID, during the COVID lock down and currently (at the time of survey). Three MAPI2 versions tracking different implementation characterizations were examined by regression analysis with robust standard errors, testing associations between provider characteristics in each version of the MAPI2. Results: In the unadjusted MAPI2, the mean count of accommodations increased from 1.2 accommodations pre-COVID-19 to 3.2 during the COVID shutdown, and remained at 3.1 at the time of the survey. The two other versions of the MAPI2, the adjusted and the relevant MAPI2, exhibited a similar pattern of increase and leveling off across the three time periods. Paired t-tests on the three index versions found significant increases in the index scores between the pre-COVID and COVID shutdown periods. No significant differences were found between the COVID shutdown and time of survey periods, suggesting continued implementation of most accommodations at the time of survey. Significant associations were found between various provider characteristics and degree of implementation as measured by the indices. Specifically, providers with larger patient limits and those offering methadone treatment were found to have higher levels of accommodation implementation as measured by the MAPI2. MAPI2 was found to have excellent content validity, acceptable internal consistency, and strong construct validity. Conclusions: The MAPI2 can be used to assess the implementation of newly allowed MOUD access accommodations both between MOUD providers and over time. As wide variation exists in MOUD accommodations implementation nationally, MAPI2 offers a tool to track changes in MOUD accessibility over time and across individual providers and locations. It will be an important tool given anticipated federal expansion of MOUD treatment accommodations.