Quantifying diagnosis and treatment practices of opioid use disorder in primary care practices using chart review data

Abstract

Background: Opioid misuse is a significant public health crisis. The aim sought to identify potential gaps in opioid care in primary care practices. Methods: American Academy of Family Physicians (AAFP) offered a monthly online educational series to seven U.S. practices. Practices were asked to complete up to 50 chart reviews for visits during two periods: February–April, 2019, and February–April, 2022. Each chart had to have an ICD-10 diagnosis of opioid misuse, opioid dependence, or opioid use. Chart reviews consisted of 14 questions derived from an American Academy of Addiction Psychiatry (AAAP) Performance in Practice activity, and then, scored based on practices’ responses. Descriptive statistics and binary logistic and multinomial regressions were used. Results: Both periods had 173 chart reviews (total: 346) from the six practices. Most chart reviews were for patients with a diagnosis of opioid dependence (2019: 90.2%; 2022: 83.2%). Three questions for assessing OUD treatment behaviors had high levels of documentation across both time periods (>85%): other drug use, treatment readiness, and treatment discussion. Discussion: Results show a gap in the treatment of patients with OUD in primary care across several clinical practice recommendations. Conclusions: Expanding OUD treatment integration to primary care remains the most promising effort to combat the opioid crisis.