评估取消对执业护士开具丁丙诺啡治疗阿片类药物使用障碍的监管要求的成本效益

IF 4.2 4区 医学 Q1 NURSING
Phillip M. Hughes MS, Melinda Ramage MSN, Kristin H. Gigli PhD, MSN, Casey R. Tak PhD, MPH
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引用次数: 0

摘要

背景:执业护士(NPs)是阿片类药物使用障碍治疗队伍中的关键组成部分。然而,在法规限制非营利组织执业范围的州,有资格提供这种重要治疗的非营利组织比拥有完全执业权限的州更少。目的:评估在历史背景下(在实施《主流成瘾治疗法》和《药物获取和培训扩展法》之前,统称为《MAT/MATE法案》)和情景中,相对于拟为阿片类药物使用障碍开具丁丙诺啡处方的NPs的有限执业范围,全面执业权限的成本效益对这些行为的各种实现进行建模。方法:一个由10000名NP组成的模拟队列通过一年时间范围的决策树模型进行研究。结果包括开具丁丙诺啡处方的NPs数量、接受治疗的患者数量以及两种结果的增量成本效益比。模型输入来源于现有文献。我们使用10000次模拟马尔可夫试验的概率不确定性分析来检验结果的不确定性和可变性。研究了描述MAT/MATE法案各种实施方式的几个场景,例如采用“书面”法案和增加医生处方。结果:在我们的基本病例MAT/MATE前分析中,全科医生授权开出丁丙诺啡的NPs比限制执业范围多245例(377例对132例),治疗的患者多2162例(3329例对1167例),同时节省5970万美元(60万美元对6030万美元)。在10000次概率不确定性分析模拟中,完全实践权威成为主导策略的概率为100%(即,在提高结果的同时节省资金)。这些结果在我们检查的所有MAT/MATE场景中都是稳健的。结论:对NPs采用完全的执业权限似乎是一种具有成本效益的政策杠杆,可以增加可用的药物使用治疗队伍,增加接受丁丙诺啡治疗的患者数量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessing the Cost-Effectiveness of Removing Supervision Requirements for Nurse Practitioners Prescribing Buprenorphine for Opioid Use Disorder

Background: Nurse practitioners (NPs) are a critical part of the opioid use disorder treatment workforce. However, in states where regulations restrict NPs’ scope of practice, fewer NPs are eligible to provide this important treatment than in states where NPs have full practice authority. Purpose: To evaluate the cost-effectiveness of full practice authority relative to restricted scope of practice for NPs intending to prescribe buprenorphine for opioid use disorder in the historical context (before implementation of the Mainstreaming Addiction Treatment Act and the Medication Access and Training Expansion Act, collectively referred to as the MAT/MATE Acts) and in scenarios modeling various implementations of these acts. Methods: A simulated cohort of 10,000 NPs progressed through a decision tree model with a 1-year time horizon. Outcomes included the number of NPs prescribing buprenorphine, the number of patients treated, and the incremental cost-effectiveness ratio for both outcomes. Model inputs were sourced from existing literature. We examined uncertainty and variability in the outcomes using a probabilistic uncertainty analysis of 10,000 simulated Markov trials. Several scenarios depicting various implementations of the MAT/MATE Acts were examined, such as adoption of the Acts “as written” and increased physician prescribing. Results: In our base-case pre-MAT/MATE analysis, full practice authority produced 245 more NPs prescribing buprenorphine than restricted scope of practice (377 vs. 132) and 2,162 more patients treated (3,329 vs. 1,167) while saving $59.7 million ($0.6 million vs $60.3 million). Across 10,000 probabilistic uncertainty analysis simulations, there was a 100% probability of full practice authority being the dominant strategy (i.e., saving money while improving outcomes). These results were robust across all MAT/MATE scenarios we examined. Conclusion: Adopting full practice authority for NPs appears to be a cost-effective policy lever for increasing the available substance use treatment workforce and increasing the number of patients receiving treatment with buprenorphine.

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来源期刊
CiteScore
4.60
自引率
12.50%
发文量
50
审稿时长
54 days
期刊介绍: Journal of Nursing Regulation (JNR), the official journal of the National Council of State Boards of Nursing (NCSBN®), is a quarterly, peer-reviewed, academic and professional journal. It publishes scholarly articles that advance the science of nursing regulation, promote the mission and vision of NCSBN, and enhance communication and collaboration among nurse regulators, educators, practitioners, and the scientific community. The journal supports evidence-based regulation, addresses issues related to patient safety, and highlights current nursing regulatory issues, programs, and projects in both the United States and the international community. In publishing JNR, NCSBN''s goal is to develop and share knowledge related to nursing and other healthcare regulation across continents and to promote a greater awareness of regulatory issues among all nurses.
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