Subtypes and service utilization among opioid use disorder patients at a community health center: findings from a medically underserved urban area of the Northeastern United States

Abstract

Background: Opioid use disorder often co-occurs with other mental health and substance use disorders. Identifying clusters of individuals receiving treatment for opioid use disorder based on co-diagnosed conditions, healthcare plans, and service utilization over a seven-year treatment period provides insight into service needs. Objectives included [1] characterizing the sample [2], examining subtypes of the sample using cluster analysis, and [3] identifying differences in Current Procedural Terminology by subtype to examine service utilization among identified clusters. Methods: This study uses secondary data from the electronic medical records of a community health center in a large urban area in the Northeastern United States from 2015 to 2021. The study sample included N = 705 adults who had an opioid use disorder diagnosis as indicated by the community health center’s electronic medical records. Measures include [1] age [2], race and ethnicity [3], sex [4], healthcare plan(s) [5], co-occurring mental health disorder [6], co-occurring substance use disorder [7], co-occurring mental health disorder or substance use disorder, and [8] Current Procedural Terminology codes for behavioral health service utilization. Cluster analysis was used to examine the sample. These clusters were then analyzed for service utilization with a one-way analysis of variance. Results: The cluster analysis identified six clusters with an average silhouette of 0.5, indicating good clustering. These six clusters were operationalized as [1] Medicare/Medicaid healthcare plan with substance use disorder needs [2], Private pay and charity care healthcare plan with cocaine use disorder needs [3], Medicare/Medicaid and other publicly-funded healthcare plans with mood disorder needs [4], Private healthcare plan with low co-occurring disorder needs [5], Other publicly-funded healthcare plan with cannabis use disorder needs [6], Medicare/Medicaid healthcare plan with mental health disorder needs. Service utilization differed between these clusters with cluster mean differences for psychotherapy sessions (F = 8.55, p < 0.001), psychiatric sessions (F = 22.72, p < 0.001), and group therapy sessions (F = 10.76, p < 0.001). Conclusions: This study highlights the importance of comprehensive and integrated treatment for substance use disorders and mental health disorders, particularly for those in underserved communities. Healthcare coverage, a socioeconomic factor that impacts access to care, is critical in distinguishing treatment needs and utilization.