- Hser, Yih-Ing;
- Mooney, Larissa;
- Baldwin, Laura-Mae;
- Ober, Allison;
- Marsch, Lisa;
- Sherman, Seth;
- Matthews, Abigail;
- Clingan, Sarah;
- Fei, Zhe;
- Dopp, Alex;
- Curtis, Megan;
- Osterhage, Katie;
- Hichborn, Emily;
- Lin, Chunqing;
- Black, Megan;
- Calhoun, Stacy;
- Holtzer, Caleb;
- Nesin, Noah;
- Bouchard, Denise;
- Ledgerwood, Maja;
- Gehring, Margaret;
- Liu, Yanping;
- Ha, Neul;
- Murphy, Sean;
- Hanano, Maria;
- Saxon, Andrew;
- Zhu, Yuhui
PURPOSE: The use of telemedicine (TM) has accelerated in recent years, yet research on the implementation and effectiveness of TM-delivered medication treatment for opioid use disorder (MOUD) has been limited. This study investigated the feasibility of implementing a care coordination model involving MOUD delivered via an external TM provider for the purpose of expanding access to MOUD for patients in rural settings. METHODS: The study tested a care coordination model in 6 rural primary care sites by establishing referral and coordination between the clinic and a TM company for MOUD. The intervention spanned approximately 6 months from July/August 2020 to January 2021, coinciding with the peak of the COVID-19 pandemic. Each clinic tracked patients with OUD in a registry during the intervention period. A pre-/post-intervention design (N = 6) was used to assess the clinic-level outcome as patient-days on MOUD based on patient electronic health records. FINDINGS: All clinics implemented critical components of the intervention, with an overall TM referral rate of 11.7% among patients in the registry. Five of the 6 sites showed an increase in patient-days on MOUD during the intervention period compared to the 6-month period before the intervention (mean increase per 1,000 patients: 132 days, P = .08, Cohens d = 0.55). The largest increases occurred in clinics that lacked MOUD capacity or had a greater number of patients initiating MOUD during the intervention period. CONCLUSIONS: To expand access to MOUD in rural settings, the care coordination model is most effective when implemented in clinics that have negligible or limited MOUD capacity.