An Index for Evaluating MOUD Capability at Primary Care Centers

An used syringe is discarded while prescription medication is strewn about haphazardly.
A research team has developed the Integrating Medications for Addiction Treatment (IMAT) Index to guide high-capability medications for opioid use disorder (MOUD) practice.

The Integrating Medications for Addition Treatment (IMAT) Index may be a valuable instrument for assessing and increasing the proportion of patients with medications for opioid use disorder (MOUD) among all patients with opioid use disorder (OUD) at a health care center. These findings were published in the Journal of Substance Abuse Treatment.

This tool comprises 7 dimensions with 47 unique items. The dimensions are infrastructure (leadership support, insurance coverage), clinic culture and environment (staff attitudes, stigma, and outreach), patient identification and initiation of care (screening, toxicology, treatment options), care delivery and treatment (referrals, retention), care coordination (team protocols, patient tracking), workforce (administrative capacity, licensing protocols), and staff training and development (ongoing staff activities). The instrument was used to evaluate 41 clinics at baseline and at a 9-month follow-up.

The participating clinics were in the start-up (53.7%) or scale-up (46.3%) phase, 82.9% were in an urban setting, and 68.3% were federally qualified health centers.

Clinics employed an average of 109.4±157.6 staff and had 16.3±34.2 physicians, 4.6±6.0 certified nurse practitioners, 1.8±2.5 physician assistants, 0.4±0.6 addiction certified physicians, and 0.8±1.1 psychiatrists.

The average IMAT score at baseline compared with follow-up was 2.95±0.64 vs 3.60±0.56 points for start-up clinics and 3.62±0.55 vs 4.04±0.58 points for scale-up clinics. Both baseline (F[1,39], 12.45; P <.05) and follow-up (F[1,39], 6.18; P <.05) scores differed between clinic types. IMAT was found to have reliable internal consistency (Cronbach’s a, 0.95).

Stratified by IMAT dimension, scores for each dimension differed significantly except for infrastructure between clinic types.

The proportion of patients prescribed MOUD of all those with OUD was predicted by IMAT score (F[3,29], 3.40; P =.03; adjusted R2, 0.18). For every 1-point increase in IMAT, there was a 0.19 increase in patients prescribed MOUD and 18% of the variance in proportion of patients on MOUD at follow-up was explained by IMAT.

The final predictive model for IMAT included change in IMAT score (b, 0.18; standard error [SE], 0.08; P =.02) and baseline proportion of patients with MOUD of all patients with OUD (b, 0.27; SE, 0.13; P =.05).

This tool may have some limited internal consistency and requires additional validation and refinement.

The study authors concluded the IMAT Index may be useful for measuring and improving MOUD capability at primary care centers.


Garneau HC, Hurley B, Fisher T, et al. The Integrating Medications for Addiction Treatment (IMAT) index: A measure of capability at the organizational level. J Subst Abuse Treat. Published online April 9, 2021. doi:10.1016/j.jsat.2021.108395