30-Month Impact of Medications for Opioid Use Disorder on Acute Care Utilization in Rural Communities.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Daniel Maeng, Holly A Russell, Kenneth R Conner, Jade Malcho, Wendi Cross, Hochang B Lee
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引用次数: 0

Abstract

Purpose: To assess both the short- and longer-term impact of offering medications for opioid use disorder (MOUD, ie, methadone, buprenorphine, or naltrexone) on rates of all-cause emergency department (ED) visits and acute inpatient admissions (IP) over a 30-month period among Medicaid enrollees with opioid use disorder (OUD) residing in rural communities.

Methods: A quasi-experimental retrospective analysis of longitudinal Medicaid claims data among continuously enrolled adult patients with OUD residing in 71 predominantly rural counties in the United States between 2018 and 2020. A cohort of patients receiving MOUD treatment was compared against a contemporaneous propensity score-matched comparison group consisting of those who received no MOUD during the period.

Findings: The sample included 5370 patients with OUD in each group. At the index period (ie, the month in which any MOUD was used for the first time), buprenorphine was the most commonly used MOUD (82% of the MOUD treatment group). By the eighth month since the index period, MOUD use dropped below 60% among the MOUD treatment group. Over the 30-month post-MOUD period, MOUD treatment was associated with 24% (112 vs 148 per 1000 per month) and 52% (21 vs 44) lower rates of ED visit and IP admission rates, respectively (P < 0.001), relative to the comparison group. Moreover, the reductions persisted well after the 18th month period.

Conclusions: Receipt of MOUD was associated with both immediate- and long-term lower rates in acute care utilization rates among adult Medicaid beneficiaries with OUD residing in rural communities despite significant treatment discontinuation.

阿片类药物使用障碍 30 个月对农村社区急症护理使用率的影响》(Medications for Opioid Use Disorder on Acute Care Utilization in Rural Communities)。
目的:评估提供阿片类药物使用障碍(MOUD,即美沙酮、丁丙诺啡或纳曲酮)药物对居住在农村社区的阿片类药物使用障碍(OUD)医疗补助参保者在 30 个月内全因急诊室就诊率和急性住院率的短期和长期影响:对 2018 年至 2020 年期间居住在美国 71 个以农村为主的县的连续注册的阿片类药物使用障碍成年患者的纵向医疗补助报销数据进行准实验性回顾分析。将接受 MOUD 治疗的患者队列与同期倾向得分匹配的对比组(包括在此期间未接受 MOUD 治疗的患者)进行了比较:每组样本包括 5370 名 OUD 患者。在指数期(即首次使用任何 MOUD 的月份),丁丙诺啡是最常用的 MOUD(占 MOUD 治疗组的 82%)。到了指数期后的第八个月,MOUD治疗组的MOUD使用率降至60%以下。在 MOUD 治疗后的 30 个月内,与对比组相比,MOUD 治疗组的急诊室就诊率和 IP 入院率分别降低了 24% (112 vs 148 per 1000 per month)和 52% (21 vs 44)(P < 0.001)。此外,在第18个月之后,这种降低趋势仍在持续:接受 MOUD 治疗与居住在农村社区的患有 OUD 的成年医疗补助受益人急症护理使用率的即时和长期降低有关,尽管治疗中断率很高。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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