Primary Submission Category: Health care/services
Rural-Urban Differences in the Availability of Hospital Transitional Opioid Programs in the United States
Authors: Berkeley Franz Ji Chang Zoe Lindenfeld Cory Cronin Jose Pagan
Presenting Author: Berkeley Franz*
Hospitals bear a significant burden of the opioid crisis and are an ideal setting to stage opioid-related interventions with patients who are hospitalized secondary to overdose or infectious disease complications. Within hospitals, transitional opioid programs (TOPs), including the initiation of medications for opioid use disorder (OUD) and addiction consult services to link patients with outpatient treatment have become the gold standard. Although effective interventions for opioid use disorder exist, it’s not clear if there are gaps in access. The aim of this study was to assess whether rural hospitals, which face considerable resource shortages, currently offer TOPs as often as their urban counterparts. Using data from the 2021 American Hospital Association Annual Survey, we conducted multivariable regression models to assess differences in screening for opioid use disorder, as well as addiction medicine consult services across different settings within rural and urban hospitals, controlling for hospital and community-level factors. Although rural hospitals do not have lower odds of screening for OUD, they have significantly lower odds of having addiction consult services in either the emergency department (OR: .767) or inpatient setting (OR: .748). These findings remain after controlling for known predictors of hospital resources, including bed size, hospital ownership, and indicators of need, including rates of opioid prescribing and overdoses in the surrounding county. Rural communities have been uniquely affected by opioid-related mortality and infectious disease transmission. Despite this impact, our study suggests that evidence-based interventions, such as TOPs, are less likely to be available in rural hospitals which may contribute to rural-urban disparities in health outcomes secondary to OUD. A priority for population health improvement should be developing implementation strategies to support rural hospital adoption of TOPs.