Impact of a Multi-Factorial Primary Care Intervention on Opioid Use Disorder Treatment and Overdose Outcomes.

Abstract

The PINPOINT (PaIn aNd oPiOId maNagemenT) intervention in Oregon aimed to support primary care clinics in applying evidence-based guidelines for pain management and opioid use disorder treatment. We evaluated the impact of this intervention on opioid use disorder treatment and overdose outcomes. Data from the voluntary Oregon All Payer All Claims datasets were integrated with several administrative datasets to create the Provider Results of Opioid Management and Prescribing Training dataset, which tracks clinical and prescribing activities at the provider level. We employed difference-in-differences models to assess the impact of PaIn aNd oPiOId maNagemenT enrollment on changes in opioid use disorder treatment and overdose outcomes. The intervention sample consisted of 289 primary care providers from clinics participating in PaIn aNd oPiOId maNagemenT, compared with 2000 control providers identified through administrative claims. The difference-in-differences models indicated statistically significant associations between intervention enrollment and treatment with medications for opioid use disorder (incidence rate ratio [IRR] = 1.214, 95% confidence interval [CI] = 1.100-1.340), any substance use disorder treatment (IRR = 1.120, 95% CI = 1.070-1.172), and any outpatient opioid use disorder treatment (IRR = 1.102, 95% CI = 1.034-1.175) compared to controls. No statistically significant changes were observed in overall non-fatal drug overdoses, non-fatal opioid overdoses, and naloxone overdose reversals, though absolute event rates were low. We found that multi-faceted, evidence-based approaches to improve clinical practice in primary care settings were associated with increased treatment for opioid use disorder, however differences in overdose outcomes were not observed. Further research is needed to assess the scalability and clinical impact of these interventions across diverse care environments.