Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality An Audit Study
Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality An Audit Study
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DOI：
10.7326/m18-3457
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发表时间：
2019-07-02
影响因子：
39.2
通讯作者：
Barnett, Michael L.
中科院分区：
文献类型：
--
作者：
Beetham, Tamara;Saloner, Brendan;Barnett, Michael L.
背景资料：改善阿片类药物使用障碍的治疗机会是国家的优先事项，但对寻求丁丙诺啡-纳洛酮的患者遇到的障碍知之甚少目的：评估无保险或医疗补助覆盖的报告当前海洛因使用的患者在现实世界中获得丁丙诺啡治疗的情况。设计：审计调查（“秘密购物者”研究）。设置：阿片类药物相关死亡率高负担的6个美国司法管辖区（马萨诸塞州、马里兰州、新罕布什尔州、西弗吉尼亚州、俄亥俄州和哥伦比亚特区）。从2018年7月到11月，来电者两次联系了546名公开列出的丁丙诺啡处方者，冒充未投保或医疗补助覆盖的患者寻求丁丙诺啡治疗。测量：提供的新预约率，首次就诊时是否可以开丁丙诺啡处方，以及等待时间。结果：在与546名临床医生的1092次联系中，849次呼叫（78%的应答率）达到了呼叫者。临床医生为54%的医疗补助联系人和62%的无保险自费联系人提供了新的预约，而27%的医疗补助联系人和41%的无保险自费联系人在第一次就诊时提供了丁丙诺啡处方的预约。对于医疗补助联系人，首次预约的中位等待时间为6天（四分位数间距[IQR]，2至10天），对于无保险的自费联系人，为5天（IQR，1至9天）。无论临床医生类型或付款人身份如何，这些等待时间都相似。从首次接触到可能的丁丙诺啡诱导的中位等待时间为8天（IQR，4至15天）医疗补助和7天（IQR，3至14天）。局限性：调查样本仅包括公开列出的丁丙诺啡处方者。结论：许多丁丙诺啡处方者没有向报告积极使用海洛因的来电者提供新的预约或快速丁丙诺啡，特别是那些有医疗补助的人。然而，等待时间并不长，这意味着可能存在机会，以增加通过使用现有的处方劳动力的访问。
Background: Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment.Objective: To assess real-world access to buprenorphine treatment for uninsured or Medicaid-covered patients reporting current heroin use.Design: Audit survey ("secret shopper" study).Setting: 6 U.S. jurisdictions with a high burden of opioid-related mortality (Massachusetts, Maryland, New Hampshire, West Virginia, Ohio, and the District of Columbia).Participants: From July to November 2018, callers contacted 546 publicly listed buprenorphine prescribers twice, posing as uninsured or Medicaid-covered patients seeking buprenorphine treatment.Measurements: Rates of new appointments offered, whether buprenorphine prescription was possible at the first visit, and wait times.Results: Among 1092 contacts with 546 clinicians, schedulers were reached for 849 calls (78% response rate). Clinicians offered new appointments to 54% of Medicaid contacts and 62% of uninsured-self-pay contacts, whereas 27% of Medicaid and 41% of uninsured-self-pay contacts were offered an appointment with the possibility of buprenorphine prescription at the first visit. The median wait time to the first appointment was 6 days (interquartile range [IQR], 2 to 10 days) for Medicaid contacts and 5 days (IQR, 1 to 9 days) for uninsured-self-pay contacts. These wait times were similar regardless of clinician type or payer status. The median wait time from first contact to possible buprenorphine induction was 8 days (IQR, 4 to 15 days) for Medicaid and 7 days (IQR, 3 to 14 days) for uninsured-self-pay contacts.Limitation: The survey sample included only publicly listed buprenorphine prescribers.Conclusion: Many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to callers reporting active heroin use, particularly those with Medicaid coverage. Nevertheless, wait times were not long, implying that opportunities may exist to increase access by using the existing prescriber workforce.Primary Funding Source: National Institute on Drug Abuse.