title: Medication-assisted treatment for substance use disorders within a national community health center research network.
abstract: The Affordable Care Act increases access to treatment services for people who suffer from substance use disorders (SUDs), including alcohol use disorders (AUDs) and opioid use disorders (OUDs). This increased access to treatment has broad implications for delivering health services and creates a dramatic need for transformation in clinical care, service lines, and collaborative care models. Medication-assisted treatments (MAT) are effective for helping SUD patients reach better outcomes. This article uses electronic health record (EHR) data to examine the prevalence of EHR-documented SUDs, patient characteristics, and patterns of MAT prescribing and screening for patients within the Community Health Applied Research Network (CHARN), a national network of 17 community health centers that facilitates patient-centered outcomes research among underserved populations.
  
  
  
  Hierarchical generalized linear models examined patient characteristics, SUD occurrence rates, MAT prescription, and human immunodeficiency virus (HIV) and hepatitis virus C screening for patients with AUDs or OUDs. Results: Among 572,582 CHARN adult patients, 16,947 (3.0%) had a documented AUD diagnosis and 6,080 (1.1%) an OUD diagnosis. Alcohol MAT prescriptions were documented for 547 AUD patients (3.2%) and opioid MAT for 1,764 OUD patients (29.0%). Among OUD patients, opioid MAT was significantly associated with HIV screening (odds ratio [OR] = 1.31, P < .001) in OUD patients, as was alcohol MAT among AUD patients (OR = 1.30, P = .013).
  
  
  
  These findings suggest that effective opioid and alcohol MAT may be substantially underprescribed among safety-net patients identified as having OUDs or AUDs.
authors.affiliation: a School of Medicine, Oregon Health and Science University (OHSU) , Portland , Oregon , USA.|b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA.
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.affiliation: c Department of Family Medicine , Oregon Health and Science University Richmond Clinic , Portland , Oregon , USA.
authors.forename: John
authors.initials: J
authors.lastname: Muench
authors.affiliation: d Oregon Community Health Information Network (OCHIN) , Portland , Oregon , USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: McBurnie
authors.affiliation: e Community Health Applied Research Network (CHARN) Data Coordinating Center , Portland , Oregon , USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Leo
authors.affiliation: e Community Health Applied Research Network (CHARN) Data Coordinating Center , Portland , Oregon , USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Crawford
authors.affiliation: b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA.
authors.forename: Daren
authors.initials: D
authors.lastname: Ford
authors.affiliation: b School of Public Health, Oregon Health and Science University (OHSU) , Portland , Oregon , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stubbs
authors.affiliation: f Fenway Health, Harvard Medical School, and Massachusetts General Hospital , Boston , Massachusetts , USA.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.affiliation: f Fenway Health, Harvard Medical School, and Massachusetts General Hospital , Boston , Massachusetts , USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: g Departments of Family Medicine and Public Health Sciences , University of Rochester Medical Center , Rochester , New York , USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: h Association of Asian Pacific Community Health Organizations , Oakland , California , USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Wright
authors.affiliation: i Alliance of Chicago Community Health Services , Chicago , Illinois , USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Doe-Simkins
authors.affiliation: i Alliance of Chicago Community Health Services , Chicago , Illinois , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cuddeback
authors.affiliation: i Alliance of Chicago Community Health Services , Chicago , Illinois , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salisbury-Afshar
authors.affiliation: d Oregon Community Health Information Network (OCHIN) , Portland , Oregon , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000188:drug therapy / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Community health centers; medication-assisted treatment; substance use disorders