2018 年 4 个州医疗补助计划中青少年和年轻成人阿片类药物使用障碍的用药启动和接受情况:改善医疗补助质量指标。

Substance use & addiction journal Pub Date : 2024-07-01 Epub Date: 2024-01-31 DOI:10.1177/29767342241227791
Victoria Lynch, Lisa Clemans-Cope
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引用次数: 0

摘要

背景:针对青少年阿片类药物使用障碍(MOUD)的药物治疗可减少危害,但许多青少年并未接受MOUD治疗。改善青少年阿片类药物使用障碍(MOUD)的质量指标可以促进对阿片类药物使用障碍(OUD)青少年的干预:我们依赖于加利福尼亚州、科罗拉多州、马萨诸塞州和新墨西哥州的 2018 年医疗补助报销数据。我们计算了启动质量指标中包含的 OUD 青少年的百分比,以及各州启动的百分比。我们还计算了因已有 OUD 护理和接受 MOUD 而被排除在启动质量指标之外的百分比。我们比较了开始/接受 MOUD 的患者与未开始/接受 MOUD 的患者的特征,并比较了调整年龄和健康状况后各州的估计值:对开始治疗的估计值不包括大约一半的 OUD 青少年,因为他们正在接受 OUD 治疗,无法观察到他们开始治疗的情况。在新接受 OUD 治疗的青少年中,每 4 人中只有 1 人开始接受治疗,各州的估计值从 18.9% 到 40.1% 不等。在已经接受过 OUD 治疗的青少年中,有一半以上接受了 MOUD 治疗,各州的估计比例从 35.2% 到 71.3% 不等。开始接受 "谅解备忘录 "治疗或接受 "谅解备忘录 "治疗的青少年患有更严重的药物依赖性疾病,但同时患有药物使用障碍或精神或身体健康诊断的青少年较少。在对年龄和健康状况进行调整后,各州的 MOUD 仍然存在很大差异:结论:大多数新确诊为 OUD 的青少年没有接受 MOUD,但超过半数确诊为 OUD 的青少年接受了 MOUD。对现有护理中的青少年进行分类、调整并纳入的 MOUD 质量指标,可为更好地支持可能选择 MOUD 的青少年提供更多的机会。应进一步研究各州的差异,以了解可能影响 MOUD 的政策。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initiation and Receipt of Medication for Opioid Use Disorder Among Adolescents and Young Adults in 4 State Medicaid Programs in 2018: Improving Medicaid Quality Metrics.

Background: Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD).

Methods: We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions.

Results: Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states.

Conclusions: Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.

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