在华盛顿州最初的 "中心辐射 "队列中，中心和治疗特征与客户结果之间的关系。

0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment Pub Date : 2024-10-20 DOI:10.1016/j.josat.2024.209544

Sharon Reif , Maureen T. Stewart , Shay M. Daily , Mary F. Brolin , Margaret T. Lee , Lee Panas , Grant Ritter , Morgan C. Shields , Shayna B. Mazel , Jennifer J. Wicks

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引用次数: 0

摘要

导言：华盛顿州的 Hub and Spoke（HS）方法旨在改善阿片类药物使用障碍（OUD）治疗的可用性。华盛顿州最初资助了六个具有阿片类药物使用障碍（MOUD）药物治疗专业知识的中心，这些中心与转诊和治疗合作伙伴（辐条）建立了护理网络。考虑到 HS 的作用和治疗特点，我们对最初 HS 队列的治疗结果进行了评估：我们使用 2017-2019 年医疗补助（Medicaid）理赔数据对 2841 名年龄在 18-64 岁的 HS 参与者进行了队列观察研究，其中不包括上月 MOUD 患者，并进行了意向治疗分析。我们描述了治疗特征（首次 HS 就诊时的 MOUD 类型、治疗环境和枢纽类型，第一个 HS 月的门诊服务次数）和 6 个月的结果（MOUD 连续性、急诊科（ED）利用率、住院和 SUD 密集治疗）。我们使用多变量回归评估与六个月结果的关联，并对客户特征进行调整：三分之二（68%）的参与者在初次就诊时接受了丁丙诺啡治疗，22%接受了美沙酮治疗，5%接受了纳曲酮治疗，5%接受了无MOUD门诊治疗。在 6 个月内，45% 的人去了急诊室，14% 的人住院治疗，18% 的人接受了 SUD 强化治疗。只有 24% 的人在 6 个月内仍在使用 MOUD。与丁丙诺啡相比，美沙酮样本继续接受 MOUD 的几率更高（aOR = 2.81，95%CI 2.21-3.55），而纳曲酮样本的几率较低（aOR = 0.36，95%CI 0.19-0.66）。FQHC/公共卫生治疗机构的 MOUD 连续性几率更高（aOR = 1.70，95%CI 1.17-2.47），但中心类型并不显著。丁丙诺啡样本的 MOUD 连续性随着 2 次以上门诊服务的增加而增加（aOR 范围为 2.55-4.73）。与丁丙诺啡样本相比，美沙酮样本接受 SUD 强化治疗的几率较低（aOR = 0.16，95%CI 0.11-0.23）；与 SUD 机构相比，所有机构的治疗几率较低（aOR 范围 0.32-0.58）；与仅接受 SUD 治疗的中心相比，SUD + MH 和医疗/医院中心的治疗几率较低（aOR 范围 0.28-0.41）：结论：尽管采用了HS方法，但大多数参与者并没有达到6个月的MOUD连续性，不同的MOUD类型和治疗环境也存在差异。丁丙诺啡患者第一个月的门诊服务次数与MOUD连续性的几率增加和SUD强化治疗的几率减少有关。还需要做更多的工作，以在 HS 模式下改善 OUD 患者的 MOUD 持续性。

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Relationship of hub and treatment characteristics with client outcomes in the initial Washington State hub and spoke cohort

Introduction

Washington State's Hub and Spoke (HS) approach aims to improve availability of opioid use disorder (OUD) treatment. Washington initially funded six hubs with expertise in medications for opioid use disorder (MOUD) that built care networks with referral and treatment partners (spokes). We assessed outcomes for the initial HS cohort, considering the role of HS and treatment characteristics.

Methods

We conducted a cohort-based observational study using 2017–2019 Medicaid claims data for 2841 HS participants aged 18–64, excluding those with past-month MOUD, in an intent-to-treat analysis. We describe treatment characteristics (MOUD type, treatment setting, and hub type at the initial HS visit, number of outpatient services in their first HS month), and six-month outcomes (MOUD continuity, emergency department (ED) utilization, hospitalization, and intensive SUD treatment). We used multivariable regressions to assess associations with six-month outcomes, adjusting for client characteristics.

Results

Two-thirds (68 %) of participants received buprenorphine, 22 % methadone, 5 % naltrexone, and 5 % outpatient without MOUD for their initial visit. Within six months, 45 % had an ED visit, 14 % any hospitalization, and 18 % entered intensive SUD treatment. Only 24 % remained on MOUD for six months. Compared to buprenorphine, the methadone sample had higher odds of MOUD continuity (aOR = 2.81, 95%CI 2.21–3.55), and the naltrexone sample had lower odds (aOR = 0.36, 95%CI 0.19–0.66). FQHC/public health treatment settings had higher odds of MOUD continuity (aOR = 1.70, 95%CI 1.17–2.47) but hub type was not significant. MOUD continuity increased with 2+ outpatient services for the buprenorphine sample (aOR range 2.55–4.73). Odds of intensive SUD treatment were lower for the methadone sample, compared to buprenorphine (aOR = 0.16, 95%CI 0.11–0.23), all settings compared to SUD settings (aOR range 0.32–0.58), and SUD + MH and medical/hospital hubs compared to SUD only hubs (aOR range 0.28–0.41).

Conclusions

Most participants did not attain six-month MOUD continuity, despite the HS approach, with variations by MOUD type and treatment setting. The number of outpatient services in the first month for buprenorphine clients was associated with greater odds of MOUD continuity and reduced odds of intensive SUD treatment. More work is needed to improve MOUD continuity for people with OUD within the HS model.

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来源期刊

Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)

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