Integrating methadone treatment into primary care increases guideline-concordant care

Integrating methadone treatment into primary care settings improves adherence to guideline-concordant health care for opioid use disorder (OUD), according to a study published online Dec. 9 in the Annals of Internal Medicine.

Eteri Machavariani, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues compared health care use among persons with OUD receiving methadone in specialty clinics versus primary care centers in Ukraine, from January 2018 to December 2023, in a two-group randomized controlled trial.

A total of 1,459 adults with OUD initiating or receiving methadone were included: 950 were randomly assigned to the intervention (methadone delivered in primary care aided with telementoring) and 509 were randomly assigned to the control group (standardized specialty clinic care). The primary outcome was the difference in composite quality health indicator (QHI) scores at 24 months, representing access to nine primary care and eight specialty care guideline-concordant services.

The researchers found that compared with those in specialty clinics, participants in primary care settings achieved higher composite QHI scores, with a mean difference of 9.1 percentage points at 24 months. The results were similar for primary care QHI and specialty care QHI (mean difference, 12.3 and 5.2 percentage points, respectively). At 24 months, methadone retention among new patients was 67.2% and 64.7% in primary care and specialty clinics, respectively.

“Integrating methadone treatment into primary care settings improves adherence to guideline-concordant health care without compromising retention on methadone,” the authors write.

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