Real-world management of opioid use disorder in primary care 2015-2019: associations between clinical practice attributes, diagnosis, and treatment.

Expanding the treatment of opioid use disorder (OUD) remains a national priority and given constraints on treatment access, primary care may be an essential treatment context. While intervention studies within primary care have demonstrated efficacy, barriers to successful implementation and scale-up persist. The purpose of this work is to describe real-world management of OUD in primary care and assess how attributes of clinical practices are associated with rates of diagnosis and treatment. This observational study uses electronic health records from the American Family Cohort, a research dataset derived from PRIME, a Qualified Clinical Data Registry for primary care. The analytic cohort includes 854 clinical practices that were active between 2015-01-01 and 2019-12-31 and 4,767,971 patients attending those clinical practices. Overall, the OUD prevalence was 0.59% between 2015 and 2019. Approximately two-thirds of all patients with OUD and nearly 90% of all visits related to OUD were concentrated in only 50 primary care practices (5.8%). High-prevalence practices tended to be in metropolitan areas and have a higher ratio of physicians and behavioral health providers per patient. The concentrated distribution of patients with OUD in our study suggests that primary care practices are an important but underused tool for OUD. Further, targeted investment in a small number of high-volume practices may be more efficient for population health impact than universal scale-up.