South Carolina Opioid Treatment Dashboard

Background

Research suggests that the longer a patient is engaged in treatment the better their long-term prognosis will be, and longer treatment engagement is associated with more positive outcomes. Yet retaining patients in care is a challenge for many health care systems, and improving retention has been identified as an important quality indicator for substance use disorder treatment programs.

How this Dashboard Measures Retention in Treatment for Opioid Use Disorder

Only people who initiated treatment after an opioid use disorder diagnosis are included in these measures. These measures adapted from National Committee for Quality Assurance’s (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures, which are widely used insurance plan performance measures. HEDIS measures are validated, claims-based measures that give a standardized format to compare health system and plan performance across states and years. The NCQA and National Quality Forum (NQF) provide guidelines for creation of these variables that help standardize measures across plans, states, and research teams. Cutoffs and windows for inclusion – such as 14 days, 34 days, and 10.5 months – are based on clinical consensus from NCQA research and HEDIS measure development. We require consistent treatment with medication and/or psychosocial therapy without a gap of longer than 7 days for a 90-day period to count towards retention in treatment. This 90-day period does not necessarily need to immediately follow diagnosis and initiation. A patient may hypothetically be diagnosed and initiate treatment, have a lapse in treatment, and shortly after restart and be retained in treatment. Retention in psychosocial and pharmacological treatment helps patients manage their illness over the long term and work towards remission.

Story Behind the Data

Many people on Medicaid with an opioid use disorder who initiate treatment are not retained in treatment. Of adults aged 18-64 enrolled in South Carolina Medicaid who initiated psychosocial treatment for opioid use disorder, 32.5% continued psychosocial treatment for 90 days without a gap longer than 14 days. Of those who engaged in medication for opioid use disorder treatment, 62.6% continued any medication for 90 days without a gap of longer than 7 days. In summary, very few—only one in three people with opioid use disorder—are adequately retained in psychosocial treatment. Just three in five people are retained in medication treatment.

These data also show that retention in treatment rates vary across counties in the state. Percentages of those retained in psychosocial treatment for 90 days without a gap longer than 14 days ranged across counties from a low of 0% to a high of 60%. Percentages of those who continued medication treatment for 90 days without a gap longer than 7 days ranged across counties, with the lowest being 45.2% to the highest being 86.7%. Overall, psychosocial treatment retention rates are lowest in the state’s Midlands region and highest in the Upstate region. Medication treatment retention rates are lowest in the Midlands region and highest in the Upstate and Pee Dee regions. We know longer retention on medication for opioid use disorder reduces morbidity and mortality, but improving retention remains a difficult for the state.

What Works

Research on what improves retention in opioid use disorder treatment is lacking. Despite limited evidence, some approaches have promising results³¹:

• Provide services to address barriers to remaining in treatment, such as transportation and childcare. Barriers such as lack of transportation or childcare can make it challenging to access necessary services for engaging in opioid use disorder treatment. When logistical challenges are addressed, patients are more likely to attend appointments and adhere to treatment plans, leading to better outcomes. Additionally, reducing these barriers fosters a more supportive environment, encouraging patients to seek and remain in treatment consistently. Increasing telehealth options and mobile methadone programs can reduce common barriers to care and reach people in need across larger distances.
• Ensure care is patient centered and continue shared decision-making practices with patients around treatment initiation and retention. Patient-centered care is an approach to healthcare that prioritizes the needs, preferences, and values of the patient in all aspects of their care. This approach fosters a stronger therapeutic alliance, enhancing patient engagement and adherence to treatment plans. By involving patients in decisions about their care, they are more likely to remain committed to their treatment and feel empowered in their recovery journey. Additionally, shared decision-making helps tailor interventions to each individual’s circumstances, improving overall treatment outcomes and satisfaction.
• Implement treatment programs that include the use of health IT (e.g. tele-health, online programs). Opioid use disorder treatment programs that include the use of health IT may be equally as effective as those delivered using traditional, exclusively in-person approaches and can reduce barriers in access to care. Health IT tools can also support personalized care through data-driven insights, helping to tailor interventions to individual needs and preferences. Additionally, remote monitoring and digital reminders can help patients adhere to their treatment plans and manage their recovery more effectively.

Additionally, the South Carolina Center of Excellence in Addiction provides technical assistance and training and education to South Carolina’s practitioners and community leaders.