Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans
Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans
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DOI：
10.1016/j.jsat.2019.05.007
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发表时间：
2019-08-01
影响因子：
3.9
通讯作者：
Korthuis, P. Todd
中科院分区：
文献类型：
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作者：
Kraemer, Kevin L.;McGinnis, Kathleen A.;Korthuis, P. Todd
背景：物质使用障碍 (SUD) 在医疗机构中很常见，并会导致不良结果，特别是对于艾滋病毒感染者。我们在退伍军人事务部 (VA) 医疗保健系统中接受护理的 HIV 感染者和未感染者的国家样本中，在 SUD 发作后评估了 SUD 治疗和药物治疗的启动、参与和保留情况。方法：我们使用了 52,995 名 HIV 感染者和 111,229 名年龄、种族、性别和地区匹配的 VA 电子数据（2000-2015 年）。未感染的患者。我们将指数 SUD 发作定义为在过去 5 个月内没有 SUD 相关服务或药物治疗的患者中，具有相关主要或次要 ICD-9 药物使用代码的门诊或住院/住院治疗。 结果：总体而言，57,428 名 (35%) 患者至少有 1 次指数 SUD 发作。 HIV 感染者比未感染者更有可能出现至少一次 SUD 发作（35.7% vs. 34.6%；p < .001）。两组在首次 SUD 发作后开始、参与和保留 SUD 治疗的比率均 < 17%。在调整后的模型中，HW 感染患者比未感染患者更有可能在 6 个月时保留 SUD 治疗（优势比 1.10；95% 置信区间 1.04-1.16）。在 HIV 感染和未感染患者中，SUD 药物治疗的启动和参与并不常见。结论：在这个国家 VA 样本中，HIV 感染和未感染患者开始 SUD 治疗和药物治疗并不常见。对于 VA 的所有 SUD 患者来说，有必要采取干预措施来改善全方位服务的启动、参与和保留，包括 SUD 药物治疗。
Background: Substance use disorders (SUDs) are common in healthcare settings and contribute to poor outcomes, particularly in patients living with HIV. We assessed initiation, engagement, and retention in SUD treatment and pharmacotherapy following an index SUD episode in a national sample of HIV-infected and un-infected patients receiving care in the Department of Veterans Affairs (VA) healthcare system.Methods: We used electronic national VA data (years 2000-2015) from 52,995 HIV-infected and 111,229 age-, race-, gender-, and region-matched uninfected patients. We defined index SUD episodes as outpatient visits or inpatient/residential admissions with associated primary or secondary ICD-9 codes for substance use in patients without SUD-related services or pharmacotherapy in the preceding 5 months.Results: Overall, 57,428 (35%) patients had at least 1 index SUD episode. HIV-infected patients were more likely than uninfected controls to have at least one index SUD episode (35.7% vs. 34.6%; p < .001). Rates of initiation, engagement, and retention in SUD treatment after the index SUD episode were < 17% for both groups. In adjusted models, HW-infected patients were more likely than uninfected patients to be retained in SUD treatment at 6 months (Odds Ratio 1.10; 95% Confidence Interval 1.04-1.16). SUD pharmacotherapy initiation and engagement was uncommon in both HIV-infected and uninfected patients.Conclusions: In this national VA sample, initiation of SUD treatment and pharmacotherapy were uncommon for both HIV-infected and uninfected patients. Interventions to improve initiation, engagement, and retention in the full range of services, including SUD pharmacotherapy, are warranted for all patients with SUD in the VA.