Patient Perspectives, Follow-up Patterns, and Cost-Effectiveness of a Low-Threshold Mobile Medical Unit

The opioid crisis affects thousands of lives each year, despite the availability of therapies to treat opioid use disorder (OUD). Patient-level barriers (e.g. ability to seek care), healthcare system structure barriers (e.g. insurance), and social barriers (e.g. stigma) prevent motivated individuals from accessing medication therapy for OUD, including buprenorphine. Low-threshold approaches to delivering medication for OUD, such as mobile medical units, acknowledge and address these barriers by meeting individuals where they are. The services provided, populations served, and implementation lessons of mobile medical units operating in cities across the country are documented in the literature, but less is known about the patients’ perceptions and sustainability of the mobile models delivering low-threshold OUD treatment. This research proposes to explore patients’ perceptions, utilization trends, and economic value of addressing inequities in access to OUD treatment with the mobile medical care model. A qualitative analysis was conducted to ascertain the patients’ perspective on mobile unit facilitators and barriers to accessing treatment for OUD. Key facilitators to utilizing the mobile unit for treatment included a convenient location that was easy to commute to, welcoming and knowledgeable staff, receiving buprenorphine and other services onsite, logistical operations, the non-stigmatizing environment, and adaptable treatment goals. These findings highlight patients’ perceptions of a mobile unit for OUD care and validate that the mobile model addressed access barriers. Group-based trajectory modeling was used to identify patterns in patient follow-up with the mobile unit and examine patient characteristics associated with certain follow-up patterns. Five follow-up patterns were identified: slow decline, fast decline, infrequent, continued use, and single-visit. Characteristics within the five groups were generally similar, with the continued use group having the highest average number of visits in the one-year period. The slow decline group had the highest rates of insurance and of receiving buprenorphine during their visit. These findings contextualize previously reported dichotomous retention rates and provide insights into how patients may utilize the mobile unit to accomplish individualized treatment goals. A cost-effectiveness assessment, using the distributional cost-effectiveness analysis framework, to evaluate the costs and population-level benefits of the mobile unit in providing OUD treatment, and accounting for equity-relevant differential effects of having access to the mobile unit by income level. Compared to standard of care (traditional clinics), having access to a mobile unit, and the associated increase in OUD treatment access, lead to an incremental cost-effectiveness ratio of $14,604/QALY gained for the overall population with OUD. Among income-based subgroups, individuals with incomes below the poverty level experienced the greatest benefit, suggesting that mobile unit is equity promoting. As the mobile medical unit model for OUD care delivery expands, ensuring efficient use of healthcare resources requires knowledge beyond the reach and services provided by mobile units. Though the mobile medical unit model aims to minimize access barriers, a comprehensive analysis of the patients’ perceived benefits, the follow-up patterns, and the economic value of addressing inequities in access to affordable OUD care is necessary for informed implementation and/or expansion decision making.

Author dc:creator

• Kanya K Shah (24400157)

• Health Sciences
• Pharmacy

Statement dc:rights

• In Copyright
• Open Access after 2028-05-01

DOI dc:identifier

https://doi.org/10.25417/uic.32995214.v1

OAI identifier oai:identifier

oai:figshare.com:article/32995214