A mixed methods study of provider factors in buprenorphine treatment retention

•Less than half of patients achieved 180-day treatment retention.•There were large differences in retention by race and ethnicity.•High-threshold practices best explained differences in retention. Low retention is a persistent challenge in the delivery of buprenorphine treatment for opioid use disor...

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Bibliographic Details
Published in:The International journal of drug policy 2022-07, Vol.105, p.103715-103715, Article 103715
Main Authors: Gertner, Alex K., Clare, Hannah Margaret, Powell, Byron J., Gilbert, Allison R., Jones, Hendree E., Silberman, Pam, Shea, Christopher M., Domino, Marisa Elena
Format: Article
Language:English
Subjects:
Buprenorphine
Buprenorphine - therapeutic use
Humans
Low-threshold treatment
Mixed methods
North Carolina
Opiate Substitution Treatment
Opioid-Related Disorders - drug therapy
Retention
United States
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Summary:•Less than half of patients achieved 180-day treatment retention.•There were large differences in retention by race and ethnicity.•High-threshold practices best explained differences in retention. 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. 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. 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. 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.
ISSN:0955-3959
1873-4758
DOI:10.1016/j.drugpo.2022.103715