Low-threshold care, medication-assisted treatment, nurse-led care, opioid use disorder, rural health



  1. Carroll, Emily DNP, RN, CNP (Director of Clinical Care)


Background: Buprenorphine-based medication-assisted treatment (B-MAT) is a powerful, concrete intervention that can be provided by nurse practitioners (NPs) to reduce opioid-related overdoses in patients with opioid use disorder (OUD). However, multiple barriers exist to provide and access this therapy.


Local problem: A rural Midwestern county struggled with increasing OUD and scant access to B-MAT. A nurse-led, community clinic had the potential to expand access to treatment but no support structure to provide it.


Methods: In this quality improvement project, a one-group posttest-only design was used to assess treatment access, care quality, and patient characteristics.


Interventions: An evidence-based, nurse led weekly B-MAT clinic using a low-threshold, chronic-care model for treatment of OUD.


Results: The B-MAT clinic expanded county-wide access by 34% over seven months. A total of 23 patients were seen with 21 eligible for treatment with B-MAT. All nine patients with at least 90-day continuous treatment were retained in the program. Three quarters of patients had at least 30 days of active buprenorphine-naloxone coverage and 17% of all patients were lost to follow up. There were no induction-related adverse events, no fatalities, and one nonfatal overdose. In a chart review, 85% of patients met at least six of eight quality criteria.


Conclusions: This low-barrier approach to OUD expanded access to treatment and demonstrated a model stable enough to continue delivering care throughout the first 5 months of the novel coronavirus (COVID-19) pandemic. NPs in primary care settings can effectively provide B-MAT in a low-threshold, office-based setting.