Associations Between Patient-Reported Experiences with Opioid Use Disorder Treatment and Unmet Treatment Needs and Discontinuation Among Virginia Medicaid Members

Author:

Marks Sarah J.12ORCID,Pham Huyen3,McCray Neil4,Palazzolo Jennifer4,Harrell Ashley4,Lowe Jason4ORCID,Bachireddy Chethan4,Guerra Lauren1,Cunningham Peter J.1,Barnes Andrew J.1

Affiliation:

1. Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA

2. Medical Scientist Training Program, Virginia Commonwealth University, Richmond, VA, USA

3. Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA

4. Virginia Department of Medical Assistance Services, Richmond, VA, USA

Abstract

Background: Many payers, including Medicaid, the largest payer of opioid use disorder (OUD) treatment, are pursuing treatment-related quality improvement initiatives. Yet, how patient-reported experiences with OUD treatment relate to patient-centered outcomes remains poorly understood. Aim: To examine associations between Medicaid members’ OUD treatment experiences, outpatient treatment settings, demographic and social factors, and members’ self-report of unmet needs during treatment and treatment discontinuation. Methods: A sample of Virginia Medicaid members aged 21 years or older with OUD diagnoses who received outpatient OUD treatment completed a mail survey between January 2020 and August 2021 (n = 1042, weighted n = 9244). A treatment experience index was constructed from responses to four items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) relating to feelings of involvement, safety, and respect and having treatment explained in an understandable way; two additional CAHPS items: “given options for treatment” and “able to refuse treatment” were also assessed. Weighted imputed logistic regressions tested adjusted associations between members’ treatment experiences, demographic and social factors, and two outcomes capturing unmet needs during treatment and treatment discontinuation. Results: More positive scores on the treatment experiences index were associated with lower adjusted odds of reporting unmet needs during treatment (aOR: 0.52, 95% CI: 0.41-0.66) and discontinuation (aOR: 0.63, 95% CI: 0.47-0.79). Respondents with serious psychological distress had higher odds of reporting unmet needs during treatment (aOR: 1.69 95% CI: 1.14-2.51) and discontinuation (aOR: 1.84, 95% CI: 1.21-2.82), as did individuals with housing insecurity (unmet needs: (aOR: 1.65, 95% CI: 1.11-2.44); treatment discontinuation: (aOR: 1.56, 95% CI: 1.04-2.36)). Conclusion: Using a first-of-its-kind survey of Medicaid members with OUD, we found that members who had more positive treatment experiences were less likely to report unmet treatment needs and discontinue treatment. Care approaches focused on improving patient experience are critical to delivering effective, high-quality OUD treatment.

Funder

Virginia Department of Medical Assistance Services

Publisher

SAGE Publications

Subject

Psychiatry and Mental health,Medicine (miscellaneous)

Reference60 articles.

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3. Prevention and Treatment of Opioid Misuse and Addiction

4. Prior National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder trials as background and rationale for NIDA CTN-0100 “optimizing retention, duration and discontinuation strategies for opioid use disorder pharmacotherapy (RDD)”

5. Medication-Assisted Treatment of Opioid Use Disorder

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