The Wall of Evidence for Continuity of Care: How Many More Bricks Do We Need?

Otto R. Maarsingh

doi:10.1370/afm.3116

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RE: Continuity of Care and MOUD
Jeffrey D. Tiemstra

Published on: 07 June 2024

Published on: (7 June 2024)
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RE: Continuity of Care and MOUD
Jeffrey D. Tiemstra, Family Physician, Aurora Health Care
Thank you for this excellent summary of evidence supporting the value of continuity-focused primary care. I would just like to add another “brick in the wall” relating to the management of mental health issues, specifically medication treatment of opioid use disorder (MOUD). Our 2022 retrospective cohort study1 of 257 patients receiving MOUD over 3 years found a 1-year retention rate of 60% for patients receiving MOUD integrated with primary care versus a 43% retention rate for patients receiving their primary care separately. In multivariate analysis, the patients receiving integrated MOUD had a significantly lower risk of dropout (hazard ratio 0.49, 95% CI, 0.33-0.72). Our study was located in a rural area where specialty care for OUD was practically unavailable, and while this may lead some simply to conclude that primary care is better than no care, the fact that our comparison group received MOUD separately from their local primary care clearly supports the conclusion that integrated care can be better than fragmented care regardless of accessibility.

Recent research confirms what we all suspect are the reasons patients do better with integrated care. A 2023 qualitative study2 reported patients receiving MOUD integrated with their primary care appreciated the personal connection and support from their primary care physician and team, the flexibility in scheduling and access, and the convenience of receiving MOUD with their other primary care needs. Not surpris...
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Thank you for this excellent summary of evidence supporting the value of continuity-focused primary care. I would just like to add another “brick in the wall” relating to the management of mental health issues, specifically medication treatment of opioid use disorder (MOUD). Our 2022 retrospective cohort study1 of 257 patients receiving MOUD over 3 years found a 1-year retention rate of 60% for patients receiving MOUD integrated with primary care versus a 43% retention rate for patients receiving their primary care separately. In multivariate analysis, the patients receiving integrated MOUD had a significantly lower risk of dropout (hazard ratio 0.49, 95% CI, 0.33-0.72). Our study was located in a rural area where specialty care for OUD was practically unavailable, and while this may lead some simply to conclude that primary care is better than no care, the fact that our comparison group received MOUD separately from their local primary care clearly supports the conclusion that integrated care can be better than fragmented care regardless of accessibility.

Recent research confirms what we all suspect are the reasons patients do better with integrated care. A 2023 qualitative study2 reported patients receiving MOUD integrated with their primary care appreciated the personal connection and support from their primary care physician and team, the flexibility in scheduling and access, and the convenience of receiving MOUD with their other primary care needs. Not surprisingly subjects reported feeling their overall health improved when comprehensive primary care, including their MOUD, is provided by one practice.

1. Mirer AG, Tiemstra JD, Hammes NE, Cloum HM, LaFavor KJ. Integrating Buprenorphine Treatment for Opioid Use with Primary Care is Associated with Greater Retention in Treatment. J Am Board Fam Med. 2022 Jan-Feb;35(1):206-208. doi: 10.3122/jabfm.2022.01.210292

2. Incze MA, Chen D, Galyean P, Kimball ER, Stolebarger L, Zickmund S, Gordon AJ. Examining the Primary Care Experience of Patients with Opioid Use Disorder: A Qualitative Study. J Addict Med. 2023 Jul-Aug 01;17(4):401-406. doi: 10.1097/ADM.0000000000001140
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Competing Interests: None declared.