在提高初级医疗服务可及性的倡议之后，接受和保留丁丙诺啡治疗阿片类药物使用障碍。

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-05-01 Epub Date: 2024-02-08 DOI:10.1097/ADM.0000000000001275

Eric J Hawkins, Carol A Malte, Hildi J Hagedorn, Adam J Gordon, Emily C Williams, Ryan S Trim, Brittany E Blanchard, Aline Lott, Anissa N Danner, Andrew J Saxon

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引用次数: 0

摘要

目标：丁丙诺啡是一种治疗阿片类药物使用障碍（OUD）的药物，但在普通医疗机构中使用不足。此外，种族群体和合并症患者接受丁丙诺啡的比例也不平等。退伍军人健康管理局发起了一项倡议，以增加初级保健中丁丙诺啡的使用。该项目的目标是确定与参与该计划的初级保健诊所（n = 18）接受和保留丁丙诺啡有关的患者相关因素：方法：对 1 年内接受过 2 次或 2 次以上初级保健就诊且在首次初级保健就诊前一年（索引日期）诊断出 OUD 的 18 岁或 18 岁以上患者进行回顾性队列质量改进评估。接受丁丙诺啡的比例是指在指数日期后的一年内从初级保健提供者处获得 1 张或 1 张以上丁丙诺啡处方的 OUD 患者的比例，保留比例是指接受丁丙诺啡 180 天或更长时间的患者的比例：在初级医疗机构就诊的 2880 名 OUD 患者中，11.7%（95% 置信区间 [CI]，10.6%-12.9%）的患者在初级医疗机构接受了丁丙诺啡治疗，其中 58.2%（95% 置信区间 [CI]，52.8%-63.3%）的患者接受了 180 天或更长时间的丁丙诺啡治疗。酒精使用障碍（调整后的几率比 [AOR]，0.39；95% CI，0.27-0.57）、非阿片类药物使用障碍（AOR，0.64；95% CI，0.45-0.93）和严重精神疾病（AOR，0.60；95% CI，0.37-0.97）患者接受丁丙诺啡治疗的比例较低。焦虑症患者接受丁丙诺啡治疗的比例较高（AOR，1.42；95% CI，1.04-1.95）。在非西班牙裔黑人患者中，接受丁丙诺啡治疗（AOR，0.55；95% CI，0.35-0.87）和 180 天保留治疗（AOR，0.40；95% CI，0.19-0.84）的可能性较低：结论：可能需要进一步整合初级保健中的成瘾服务，以提高合并药物使用障碍患者接受丁丙诺啡治疗的机会，同时需要采取干预措施，解决非西班牙裔黑人患者接受和保留丁丙诺啡治疗方面的差异。

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Buprenorphine Receipt and Retention for Opioid Use Disorder Following an Initiative to Increase Access in Primary Care.

Objectives: Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative.

Methods: Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer.

Results: Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients.

Conclusions: Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.

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来源期刊

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.