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Retention and Continuity of Care for Rural MOUD Programs

Research has shown that retention, or continued involvement, in treatment improves patient outcomes and reduces rates of mortality from opioid use disorder (OUD). Therefore, it is important that rural programs providing medication for opioid use disorder (MOUD) address recovery maintenance and continuity of care between settings.

Successful retention in MOUD is defined differently by programs but can mean continued involvement in treatment for some period of time, often ranging from 3 months to 7 years. Patient retention can depend on a number of factors including patient characteristics and provider or service delivery factors.

Client characteristics that may positively affect retention include:

  • Older age
  • Lack of co-occurring mental or substance use disorders
  • Employment
  • Non-clinical, community-based recovery support services that address social determinants of health (such as housing assistance, child care, transportation)
  • Positive social relationships
  • Access to care
  • Culturally appropriate care

Provider or service delivery models that may positively promote retention include:

  • Nurse care manager support
  • Use of peer providers
  • Care coordination
  • Warm hand-offs
  • Treatment available in a variety of settings, such as inpatient, emergency department, HIV clinics, and correctional facilities
  • Home-delivery of medication
  • Use of telehealth

Using a holistic approach to care promotes patient retention in MOUD programs. Organizations should assess the types of treatment providers, services, and recovery supports available within the community. MOUD programs can establish meaningful relationships or formal partnerships with other providers and service agencies to offer coordinated patient care and holistic support of the individual. If possible, rural MOUD programs may also choose to house all treatment services within the same setting to mitigate barriers, like transportation to another site, which can reduce the likelihood of retention in care. You can read more about MOUD models of care in Module 2.

To ensure continued patient engagement in treatment, it is important for MOUD programs to be flexible and innovative. Often, the intake process is the first time the patient interacts with a MOUD provider, and it may be the first time the patient seeks help for OUD. Research has shown that starting medication at the first patient interaction with a provider improves retention in treatment. Therefore, it is important for programs to start MOUD as soon as patients express interest in treatment for OUD. MOUD clinics may offer walk-in appointments. They may also find ways to ensure that there is a staff member available to conduct an intake assessment as soon as an individual calls, which may include offering services after business hours.

Additionally, clearly explaining the treatment process at the first encounter, including what the patient can expect during intake, transitions, and ongoing care, has been shown to improve patient engagement in the treatment process and continuity of care. One MOUD program in rural Maine uses program coordinators to conduct the intake process and serve as the point of contact for new patients. During intake, the program coordinator gathers information about the patient, reviews program requirements, and answers questions about the treatment program. The program uses a brief intake questionnaire to assess the patient's basic needs, including availability of and access to items such as food, cell phone service, and electricity.