Background: Assessment of people affected by opioid-related problems and those receiving care is challenging due to lack of common definitions and scattered information. We sought to fill this gap by demonstrating a method to describe a continuum of opioid addiction care in a large, public safety-net institution.
Methods: Using 2017 clinical and administrative data from Denver Health (DH), we created operational definitions for opioid use disorder (OUD), opioid misuse (OM), and opioid poisoning (OP). Six stages along a continuum of patient engagement in opioid addiction care were developed, and operational definitions assigned patients to stages for a specific time point of analysis. National data was used to estimate the Denver population affected by OUD, OM and OP.
Results: In 2017, an estimated 6688 people aged ≥12 years were affected by OUD, OM, or OP in Denver; 48.4% (3238/6688) were medically diagnosed in DH. Of those, 32.5% (1051/3238) were in the medication assisted treatment stage, and, of those, 59.8% (629/1051) in the adhered to treatment stage. Among that latter group, 78.4% (493/629) adhered at least 90 days and 52.3% (329/629) for more than one year. Among patients who received medication assisted treatment, less than one third (31.3%, 329/1051) were adherent for more than one year.
Conclusions: A health-system level view of the continuum of opioid addiction care identified improvement opportunities to better monitor accuracy of diagnosis, treatment capacity, and effectiveness of patient engagement. Applied longitudinally at local, state and national levels, the model could better synergize responses to the opioid crisis.
Keywords: Continuity of patient care; Heroin; Opiate substitution treatment; Opioid crisis; Opioid-related disorders.
Published by Elsevier B.V.