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Reducing Outpatient Wait- times for Medication for Addiction Treatment (ROWMAT)

Learn how a low-barrier access clinic reduces wait times for medication, enhancing patient care, engagement, and overdose risk mitigation.

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Reducing Outpatient Wait- times for Medication for Addiction Treatment (ROWMAT)

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  1. Reducing Outpatient Wait-times for Medication for Addiction Treatment (ROWMAT) Payel Jhoom Roy, MD AMERSA 11/10/18

  2. Disclosures • I have no disclosures

  3. Introduction • According to the Substance Abuse and Mental Health Services Administration, of the 19.9 million adults aged 18 and older with a substance use disorder (alcohol or illicit drug use) in 2016, 17 million did not receive treatment for their substance use disorder, resulting in a treatment gap of 85.4%.

  4. Introduction • Reasons: • Regulation around addiction medication treatment • Long wait times • Stigmatization of addiction • Limited programs and compensation for treatment

  5. Introduction • Overall, pharmacologic therapy for alcohol and opioid use tends to be offered by physicians and nurse practitioners who have some specialization in addiction treatment. • These providers can be difficult to find • Waitlists: can take days to weeks to get an appointment • For opioids, we know overdose risk increases with each use • Goal: increase access to life-saving, FDA-approved medications for opioid and alcohol addiction

  6. Introduction: Our clinic • Faster Paths • Low barrier access • MD/RN team sees patients M-F during business hours • Patients seen on short-term basis until they can be transferred out to their primary care clinic where they can be seen long-term • Patients can walk-in or call (self referral) or have an appointment made for them by another provider • Typical wait time is <2 days • Goal: shorter wait time = improved access, increased engagement/retention in care, and decreased overdose risk

  7. Research Question • Among patients who request and receive an appointment in a low-barrier access addiction treatment clinic, how does the number of days between the date an appointment is scheduled (appointment scheduled) and the date the service is rendered (date of service) affect odds of arriving (arrived), no-showing (no show), or canceling the appointment (canceled)?

  8. Research Question – PICO • Among patients who request and receive an appointment in a low-barrier access addiction treatment clinic, does a reduced number of days between the date an appointment is scheduled (appointment scheduled) and the date the service is rendered (date of service) such as 0 or 1 day, compared to 2+ days, affect odds of arriving (arrived) or not arriving (no-showing [no show] plus canceling the appointment [canceled])? Population Intervention Control Outcome

  9. Methods: Study Participants • 806 new patients were identified using: • Inclusion criteria: • Seen between 8/1/16 and 8/31/17 • New patient • Index visit • Seen for medication treatment • Exclusion criteria: • Follow-up visits • Hospital discharge; detox referral; detox requested (but no e/o referral); no note written; no DOS; unclear; pt in ER/hosp

  10. Results: Characteristics of Patients (N=575)

  11. Results: Arrival Status and Wait Times 0=No Show; 1=Arrived

  12. Results: Univariate and multivariate logistic model predicting arrival status 1 adjusting for age, gender and distance from the hospital

  13. Discussion • Same-day access significantly increases likelihood that patients will link to outpatient addiction care. • Clear trend towards higher no-show rates and lower arrived rates as the difference in days increases.

  14. Limitations • Not able to address other covariates due to lack of data on no show groups (race/ethnicity, insurance, language) • 1 year data • One site that is a specialty clinic; lack of generalizability

  15. Conclusions • More efforts should be made to reduce wait-times for people seeking medication for addiction treatment to improve linkage to care. • This can be accomplished in low-barrier access clinics, as discussed here, or incorporated into office-based opioid treatment.

  16. Thank you! • Alex Walley, MD, Msc • Sugy Choi, MS • Integrated Care for Addiction, HIV and HCV Research and Education (ICAHRE): 1T32DA041898-01A1 • BU CTSI/CREST: 1UL1TR001430 • Research in Addiction Medicine Program (RAMS): R25DA033211 • Kathleen Masters, Regina Kelleher • Lewis Kazis, ScD; Howard Cabral, PhD, MPH

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