A new HHS OIG report revealed vast geographic care disparities in patient access to care for opioid use disorder.
Access to care for opioid use disorder is still left wanting across the United States, but is especially limited in rural areas and areas that are hard-hit by the opioid epidemic, according to a report from the HHS Office of Inspector General.
Specifically, the researchers found that provider shortages in certain areas of the US have led to care access deserts.
Federal efforts to quell the opioid crisis have largely leaned on buprenorphine, a key drug used in medication-assisted treatment (MAT) that providers can prescribe in an outpatient office setting. This makes buprenorphine preferable to the other drugs, such as methadone or naltrexone, used in MAT.
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The Buprenorphine Waiver Program, hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA), aims to boost patient access to MAT by authorizing more providers to prescribe the drug. Clinicians in outpatient office settings, community health centers, and treatment centers all qualify for authorization under the program.
But despite that program and its reported successes, access to MAT using buprenorphine still leaves much to be desired. Using data from SAMHSA, OIG found that the number of providers authorized to prescribe buprenorphine has dramatically increased since 2002. Nearly 47,000 clinicians were allowed to prescribe the drug as of 2018, the data revealed.
That said, the researchers observed little connection between the number of providers allowed to prescribe buprenorphine and the number of patients actually receiving it. In other words, just because there are providers across the nation who are theoretically able to administer MAT, patients are not receiving the treatment.
The reasons for this are manifold, the OIG report noted.
For one thing, many studies have indicated that providers authorized to prescribe buprenorphine do not fill their patient panels.
In the first year of one’s buprenorphine waiver, a provider may treat up to 30 patients with the drug. After hitting the one-year milestone, that threshold moves to 100 patients. After two years, providers may then begin treating up to 275 patients with buprenorphine.
In 2018, about three-quarters of providers had only hit that 30-patient threshold, largely because of recent pushes to expand buprenorphine access. However, further analysis showed that even after providers advance to the one- and two-year thresholds, they largely are not taking on more patients, despite regulations allowing them to.
When looking at all of the providers authorize to treat 100 or 275 patients, the researchers found that access to buprenorphine could be available to approximately 3 million individuals.
But again, that isn’t exactly happening. Data from a 2010 SAMHSA survey showed that providers in the 100-patient threshold were treating on average 43 patients per month. Providers reported limited patient demand, time constraints, and insurance reimbursement requirements as barriers to patient treatment.
What’s more, these low-patient thresholds are split over geographic lines, affecting counties where the opioid crisis is more pressing. Rural areas are far more likely to report low to no buprenorphine access, although they typically report higher incidences of opioid use disorder.
All said, 72 percent of the low or no buprenorphine access or capacity are located in rural areas. This could be due to a lack of waivered providers in these areas. Fifty-six percent of high-needs counties report limited access to a provider who can prescribe buprenorphine.
In more heartening news, Appalachia, another region markedly affected by the opioid crisis, reported high or average access to buprenorphine, OIG said. Areas in the northeast and the Pacific northwest also reported above average buprenorphine access.
But even in these areas, patients often report limited access to care. Counties and states that encompass a large geographic space may yield low patient access to care because a provider prescribing buprenorphine may still be physically far away from the patient.
A patient will be unable to visit that provider if she must travel a long distance, the report noted. For example, a singular county may have high capacity for buprenorphine prescribing, but if those providers are congregated in a single area, a patient living on the outskirts of that county may struggle for access.
Ultimately, these results suggest that although the nation sees an adequate number of providers authorized to prescribe MAT therapies, these providers are not evenly distributed. This is leading to geographic care access disparities. SAMHSA may consider strategies to drive more providers to rural and other high-needs areas to close these gaps.
For what it’s worth, this geographic care disparity issue is not foreign to the healthcare industry. The provider shortage across all specialties plagues certain areas, such as rural America, more than others. This comes even as individuals living in rural regions are more likely to have chronic illness or face certain comorbidities that make access to care important.
This latest OIG report underscores this issue by placing it amongst the backdrop of the national opioid epidemic.
Source: PatientEngagement HIT