Journal of General Internal Medicine

, Volume 34, Issue 6, pp 936–943 | Cite as

The Role of Primary Care in Improving Access to Medication-Assisted Treatment for Rural Medicaid Enrollees with Opioid Use Disorder

  • Evan S. ColeEmail author
  • Ellen DiDomenico
  • Gerald Cochran
  • Adam J. Gordon
  • Walid F. Gellad
  • Janice Pringle
  • Jack Warwick
  • Chung-Chou H. Chang
  • Joo Yeon Kim
  • Julie Kmiec
  • David Kelley
  • Julie M. Donohue
Original Research



The opioid epidemic has disproportionately affected rural areas, where a limited number of health care providers offer medication-assisted treatment (MAT), the mainstay of treatment for opioid use disorder (OUD). Rural residents with OUD may face multiple barriers to engagement in MAT including long travel distances.


To examine the degree to which rural residents with OUD are engaged with primary care providers (PCPs), describe the role of rural PCPs in MAT delivery, and estimate the association between enrollee distance to MAT prescribers and MAT utilization.


Retrospective cohort study.


Medicaid-enrolled adults diagnosed with OUD in 23 rural Pennsylvania counties.

Main Measures

Primary care utilization, MAT utilization, distance to nearest possible MAT prescriber, mean distance traveled to actual MAT prescribers, and continuity of pharmacotherapy.

Key Results

Of the 7930 Medicaid enrollees with a diagnosis of OUD, a minority (18.6%) received their diagnosis during a PCP visit even though enrollees with OUD had 4.1 visits to PCPs per person-year in 2015. Among enrollees with an OUD diagnosis recorded during a PCP visit, about half (751, 50.8%) received MAT, most of whom (508, 67.6%) received MAT from a PCP. Enrollees with OUD with at least one PCP visit were more likely than those without a PCP visit to receive MAT (32.7% vs. 25%; p < 0.001), and filled more buprenorphine and naltrexone prescriptions (mean = 11.1 vs. 9.3; p < 0.001). The median of the distances traveled to actual MAT prescribers was 48.8 miles, compared to a median of 4.2 miles to the nearest available MAT prescriber. Enrollees traveling a mean distance greater than 45 miles to MAT prescribers were less likely to receive continuity of pharmacotherapy (OR = 0.71, 95% CI = 0.56–0.91, p = 0.007).


PCP utilization among rural Medicaid enrollees diagnosed with OUD is high, presenting a potential intervention point to treat OUD, particularly if the enrollee’s PCP is located nearer than their MAT prescriber.


primary care medication-assisted treatment rural opioid use disorder 


Funding Information

This study was funded by a grant from the Agency for Healthcare Research & Quality (1R18HS025072-01).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Evan S. Cole
    • 1
    Email author
  • Ellen DiDomenico
    • 2
  • Gerald Cochran
    • 3
  • Adam J. Gordon
    • 3
  • Walid F. Gellad
    • 1
    • 4
  • Janice Pringle
    • 5
  • Jack Warwick
    • 5
  • Chung-Chou H. Chang
    • 4
  • Joo Yeon Kim
    • 1
  • Julie Kmiec
    • 6
  • David Kelley
    • 7
  • Julie M. Donohue
    • 1
  1. 1.Department of Health Policy and ManagementUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  2. 2.Pennsylvania Department of Drug and Alcohol ProgramsHarrisburgUSA
  3. 3.Department of Internal Medicine, Division of EpidemiologyUniversity of Utah School of MedicineSalt Lake CityUSA
  4. 4.Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  5. 5.Program Evaluation and Research UnitUniversity of Pittsburgh School of PharmacyPittsburghUSA
  6. 6.Department of PsychiatryUniversity of PittsburghPittsburghUSA
  7. 7.Pennsylvania Department of Human ServicesHarrisburgUSA

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