Quantifying diagnosis and treatment practices of opioid use disorder in primary care practices using chart review data

Abstract

Background:

Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices.

Methods:

American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February–April, 2019, and February–April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices’ responses. Descriptive statistics and binary logistic and multinomial regressions were used.

Results:

Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion.

Discussion:

Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations.

Conclusions:

Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.

Keywords:

• Family physicians
• opioid use disorder
• primary care
• primary care clinicians
• electronic health record

Acknowledgement

The authors would like to acknowledge the participating practices of the learning series and chart review.

Conflicts of interest

Elisabeth Callen: Dr. Callen reports grants from SAMHSA, during the conduct of the study. Tarin Clay: Ms. Clay has nothing to disclose. Cory Lutgen: Mr. Lutgen reports grants from American Academy of Addiction Psychiatry, during the conduct of the study; grants from American Academy of Addiction Psychiatry, grants from Patient-Centered Outcomes Research Institute, grants from Eli Lilly, grants from Humana, grants from Shire, grants from AHRQ, outside the submitted work. Elise Robertson: Ms. Robertson reports grants from American Academy of Addiction Psychiatry, during the conduct of the study. Elizabeth Staton: Ms. Staton has nothing to disclose. Melissa Filippi: Dr. Filippi reports grants from SAMHSA, during the conduct of the study; grants from NIH, grants from HRSA, grants from SAMHSA, grants from Abbott, grants from Eli Lilly, grants from Takeda Pharmaceuticals, outside the submitted work.

Additional information

Funding

Funding for this initiative was made possible (in part) by grant no. 1H79TI083343 from SAMHSA. The views expressed in written conference materials or publications and by speakers or moderators do not necessarily reflect the official policies of the Department of Health and Human Services (HHS); nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.