Buprenorphine prescribing practices for older adults in 2019 and 2020

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-12-04 DOI:10.1111/jgs.19291

Natalie C. Ernecoff PhD, MPH, Flora Sheng MBBS, MPH, Jonathan Cantor PhD, Bradley D. Stein MD, PhD

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引用次数: 0

Abstract

Background

Opioid use disorder (OUD) prevalence has increased threefold among Medicare beneficiaries 65 years and older (hereafter “older adults”) since 2013, with a prevalence of 15.7 per 1000 Medicare beneficiaries in 2018. Yet, access to treatment that addresses the needs of older adults with OUD is limited, including patterns of buprenorphine prescribing to older adults. Therefore, we sought to describe buprenorphine treatment patterns among older adults and prescribing clinician specialties.

Methods

We conducted a retrospective observational study using 2019–2020 IQVIA Real World Data–Longitudinal Prescriptions. High-prescribing clinicians are those who prescribed buprenorphine to >15 unique older adults within a calendar year. We used T-test and chi-square tests to compare characteristics associated with differences in prescribing.

Results

Among 26,202 clinicians prescribing buprenorphine to 67,921 unique older adults, 1232 (5%) prescribed to more than 15 older adults (mean 28.1, SD = 23.6), corresponding to buprenorphine prescribing for 24,672 (36%) older adults. Among older adults dispensed buprenorphine, the majority (58%) were 66–70 years of age and male (54%). Individuals older than 70 years (44%) and males (51%) were slightly more common among high prescribers than non-high-prescribing clinicians (41% and 49%, respectively). Primary care clinicians (42%) and advance practice providers (APPs) (29%) were the most common specialties prescribing buprenorphine. Most (87%) buprenorphine prescribers were in urban counties; with a slightly higher percentage of high-prescribing clinicians in urban counties (91%).

Conclusions

A relatively small subset of clinicians prescribes most buprenorphine to older adults. This work provides evidence of gaps in care delivery. Scalable systems-level interventions should be developed and tested to improve treatment availability mindful of existing clinical infrastructure.

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2019年和2020年老年人丁丙诺啡处方实践。

背景：自2013年以来，65岁及以上的医疗保险受益人（以下简称“老年人”）的阿片类药物使用障碍（OUD）患病率增加了三倍，2018年的患病率为每1000名医疗保险受益人15.7人。然而，满足老年OUD患者需求的治疗途径有限，包括给老年人开丁丙诺啡的模式。因此，我们试图描述丁丙诺啡在老年人和处方临床医生专业中的治疗模式。方法：采用2019-2020年IQVIA真实世界数据纵向处方进行回顾性观察研究。高处方的临床医生是那些在一个日历年内给150名独特的老年人开丁丙诺啡的医生。我们使用t检验和卡方检验来比较与处方差异相关的特征。结果：26202名给67921名特殊老年人开丁丙诺啡的临床医生中，1232名（5%）给15名以上老年人开丁丙诺啡（平均28.1,SD = 23.6），对应24672名（36%）老年人开丁丙诺啡。在使用丁丙诺啡的老年人中，大多数（58%）为66-70岁，男性（54%）。70岁以上的老年人（44%）和男性（51%）在高开处方的临床医生中略高于非高开处方的临床医生（分别为41%和49%）。初级保健临床医生（42%）和高级执业医师（29%）是最常见的丁丙诺啡处方专业。大多数（87%）丁丙诺啡处方者在城市县；城市县的高处方临床医生比例略高（91%）。结论：一小部分临床医生给老年人开丁丙诺啡。这项工作提供了医疗服务差距的证据。应开发和测试可扩展的系统级干预措施，以提高现有临床基础设施的治疗可得性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.