太平洋西北地区农村初级保健诊所对安非他明类兴奋剂使用障碍患者的处方药治疗。

IF 3.2 2区 医学 Q1 SUBSTANCE ABUSE
Megan J Yerton, Connor J McCabe, Matthew D Iles-Shih, Judith I Tsui, Kevin A Hallgren
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引用次数: 0

摘要

背景:近年来,苯丙胺类兴奋剂的使用和过量使用在美国急剧增加,主要是由甲基苯丙胺驱动的。需要增加对安非他明类兴奋剂使用障碍(AT-StUD)的治疗,包括在初级保健机构,以减轻这些问题,但有效的行为治疗往往难以获得,并且没有fda批准的AT-StUD药物。在当前的研究中,我们描述了在太平洋西北地区主要为农村服务的初级保健诊所中,临床记录的AT-StUD患者接受治疗AT-StUD的实践指南中有条件推荐的药物的频率。方法:通过data QUEST网络获得美国西北太平洋地区23家初级保健诊所的电子健康记录数据。纳入了2017年1月至2021年12月期间临床记录的“其他兴奋剂滥用”或“其他兴奋剂依赖”诊断典型反映AT-StUD的成年患者。使用处方记录确定安非他酮、米氮平、托吡酯、纳曲酮-安非他酮联合用药、哌甲酯、右苯丙胺和莫达非尼的处方。统计分析量化了在任何有记录的AT-StUD诊断后一年内用药的患者百分比。结果:患者(N = 963)以女性(53.3%)、白人(81.7%)和非西班牙裔(70.5%)为主。总的来说,14.3%的患者接受了实践指南中有条件推荐的非兴奋剂药物的处方;2.7%的人接受了兴奋剂治疗。与临床指南一致的是,当患者有记录的同时发生的疾病,药物也可能有效时,才会开药物。结论:在这个为农村服务的初级保健诊所样本中,大约七分之一的AT-StUD初级保健患者收到了初步有效证据的药物订单。需要努力增加在初级保健中获得AT-StUD治疗的机会。这些努力可包括培训卫生专业人员考虑根据临床指南明智地使用药物治疗,增加行为卫生服务的能力,包括应急管理,以及继续研究药物制剂。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prescribed medications for patients with amphetamine-type stimulant use disorder seen in rural-serving Pacific Northwest primary care clinics.

Background: Amphetamine-type stimulant use and overdoses have increased sharply across the US in recent years, largely driven by methamphetamine. Increased access to treatments for amphetamine-type stimulant use disorder (AT-StUD), including in primary care settings, is needed to mitigate these problems, yet effective behavioral treatments are often inaccessible and there are no FDA-approved medications for AT-StUD. In the current study, we characterize how often patients with clinically documented AT-StUD in predominantly rural-serving Pacific Northwest primary care clinics received medications that have been conditionally recommended in practice guidelines for treatment of AT-StUD.

Methods: Electronic health record data from 23 primary care clinics in the Pacific Northwest US were obtained through the Data QUEST network. Adult patients with clinically documented "other stimulant abuse" or "other stimulant dependence" diagnoses typically reflecting AT-StUD between 01/2017 and 12/2021 were included. Prescription records were used to identify orders for bupropion, mirtazapine, topiramate, naltrexone-bupropion combination, methylphenidate, dextroamphetamine, and modafinil. Statistical analyses quantified the percentage of patients with medication orders placed within one year after any documented AT-StUD diagnosis.

Results: Patients (N = 963) were predominantly female (53.3%), White (81.7%), and non-Hispanic (70.5%). In total, 14.3% of patients received orders for a non-stimulant medication conditionally recommended in practice guidelines; 2.7% received orders for a stimulant medication. Consistent with clinical guidelines, medications were more often prescribed when patients had documented co-occurring disorders for which the medications could also be effective.

Conclusions: In this sample of rural-serving primary care clinics, approximately 1 in 7 primary care patients with AT-StUD received orders for medications with preliminary evidence of effectiveness. Efforts are needed to increase access to AT-StUD treatments within primary care. These efforts could include training health professionals to consider judicious use of pharmacotherapy consistent with clinical guidelines, increasing capacity for behavioral health services including contingency management, and continuing research on pharmacologic agents.

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来源期刊
Addiction Science & Clinical Practice
Addiction Science & Clinical Practice Psychology-Clinical Psychology
CiteScore
3.90
自引率
10.80%
发文量
64
审稿时长
28 weeks
期刊介绍: Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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