The Role of Patient Payment Method in Premature Discharge from Methadone Maintenance Treatment

Abstract

Background: Premature discharge is a pervasive problem in methadone maintenance treatment (MMT), and is associated with numerous adverse outcomes. Although a number of demographic variables have consistently been found to impact MMT retention, method of payment has received considerably less attention. A notable limitation of prior work is that most studies classify all patients who leave treatment early, irrespective of reason, as treatment dropouts and fail to account for specific reasons. Objective: This study sought to determine whether method of payment for MMT services was associated with differential reasons for premature discharge. Methods: The sample was comprised of 4158 patients prematurely discharged from 33 MMT facilities located throughout the U.S. from 2009 to 2012. Patients were classified into two groups based on their method of payment: self-pay and insurance (largely Medicaid). Patients were studied through retrospective electronic chart review. Results: Binary logistic regression indicated that insurance patients who were prematurely discharged were significantly more likely to be discharged due to a program-initiated reason (administrative), while self-pay patients were more likely to be discharged due to a patient-initiated reason (against medical advice) after controlling for significant intake demographic and clinical covariates. Conclusions: Further research is needed to determine whether insurance patients may require different supports in place compared to self-pay patients in order to improve compliance with program guidelines (e.g. behavioral contracts providing a detailed description of rules both at admission and throughout treatment with an emphasis on the potential consequences of noncompliance), and whether self-pay patients may benefit from motivational incentives and interventions to remain engaged in treatment.

Keywords:

• Methadone
• maintenance
• discharge
• payment method
• opioids

Additional information

Funding

The original study was supported in part by CRC Health Group. The funding source was not involved in the study design, analysis, or interpretation of data. None of the authors have any additional real or potential conflicts of interest, including financial, personal, or other relationships with organizations or pharmaceutical/biomedical companies that may inappropriately influence the research and interpretation of the findings.