A - 29 Support for Use of Cognitive Rehabilitation Strategies to Enhance Accessibility of Medications for Opioid Use Disorder Treatment: a Qualitative Secondary Data Analysis

Abstract Objective Despite cognitive rehabilitation paradigms gaining support as adjunctive interventions to opioid use disorder treatments, limited research details strategies that medical providers who prescribe medications for opioid use disorder (MOUD) employ to attend to patient cognitive limitations. We conducted a secondary data analysis to explore this gap in the literature. Method The parent study included individual interviews with 23 MOUD treatment providers from New Mexico and Washington state, and the interview guide centered barriers and facilitators to equitable implementation. A deductive thematic analysis was utilized to identify sources, solutions, and strategies that MOUD providers identified for patients experiencing cognitive impairments. Results Regarding sources of cognitive dysfunction, history of stroke, overdose, severe mental illness, and traumatic brain injury were emphasized. Low health literacy was also identified as a justification to modify approach. Strategies providers utilized fell under five subthemes: visual aids; communication (e.g., repetition; open questions); engaging caregivers; leveraging peer support; and increasing visit frequency. Though less common, some providers emphasized only focusing on substance use and safety. Conclusions There have been calls to better attend to cognitive functioning as a potential moderator of MOUD treatment outcomes; however, existing personalized care guidelines do not address this adequately. The present study revealed variability in clinical decision-making that may exacerbate health inequities among individuals seeking MOUD treatment –a population disproportionately impacted by social determinants of health (e.g., housing; access to healthcare; quality of education). Greater focus on equitable MOUD implementation is needed to explore methods of personalizing care for individuals seeking MOUD treatment presenting with cognitive dysfunction.