The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada
The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada
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DOI：
10.1111/add.14947
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发表时间：
2020-02-06
期刊：
影响因子：
6
通讯作者：
Nosyk, Bohdan
中科院分区：
文献类型：
--
作者：
Piske, Micah;Zhou, Haoxuan;Nosyk, Bohdan
背景与目的
“照护级联”框架用于衡量在照护参与的各个阶段的损耗情况，已被提出用于指导加拿大不列颠哥伦比亚省针对阿片类药物过量这一公共卫生紧急事件的公共卫生应对措施。我们估算了阿片类药物使用障碍的照护级联情况，并确定了该省阿片类药物使用障碍患者（PWOUD）与照护参与相关的因素。
设计
利用四个卫生管理数据库的省级关联进行回顾性研究。
环境与参与者
1996年1月1日至2017年11月30日期间不列颠哥伦比亚省的所有阿片类药物使用障碍患者。
测量
八级照护级联包括被诊断为阿片类药物使用障碍患者、曾经接受过阿片类激动剂治疗（OAT）、近期接受过OAT、目前正在接受OAT以及在OAT治疗中保持的时间（≥1个月、≥3个月、≥12个月和≥24个月）。医疗保健使用情况、无家可归状况及其他人口统计学信息来自医生诊疗收费记录、住院记录和药品配给记录。是否领取收入援助通过是否参加药物保健计划C来表明。
结果
在随访结束时，共有55470名被诊断为阿片类药物使用障碍的患者仍然存活。截至2017年，大部分患者（n = 39456；71%）在随访期间接受了OAT治疗；然而，只有33%（n = 18519）目前正在接受治疗，16%（n = 8960）保持治疗至少1年。与从未接受过OAT治疗的患者相比，目前正在接受OAT治疗的患者更有可能年龄在45岁以下[调整后的优势比（aOR）= 1.75，95%置信区间（CI）= 1.64，1.89]，为男性（aOR = 1.72，95%CI = 1.64，1.82），同时患有物质使用障碍（aOR = 2.56，95%CI = 2.44，2.70）、丙型肝炎病毒（HCV）感染（aOR = 1.22，95%CI = 1.14，1.33）以及无家可归或领取收入援助（aOR = 4.35，95%CI = 4.17，4.55）。无论自诊断或停止治疗以来的时间长短，在未接受OAT治疗的阿片类药物使用障碍患者中，在门诊或急诊环境下与医疗保健系统的定期接触都很常见。
结论
加拿大不列颠哥伦比亚省的阿片类药物使用障碍患者在诊断前显示出较高水平的门诊照护。较年轻、男性、城市居住、较低收入水平和无家可归似乎与增加阿片类激动剂治疗参与度独立相关。
Background and Aims The 'cascade of care' framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia, Canada. We estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially.Design Retrospective study using a provincial-level linkage of four health administrative databases.Setting and participants All PWOUD in BC from 1 January 1996 to 30 November 2017.Measurements The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: >= 1, >= 3, >= 12 and >= 24 months). Health-care use, homelessness and other demographics were obtained from physician billing records, hospitalizations, and drug dispensation records. Receipt of income assistance was indicated by enrollment in Pharmacare Plan C.Findings A total of 55 470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (n = 39 456; 71%) received OAT during follow-up; however, only 33% (n = 18 519) were currently engaged in treatment and 16% (n = 8960) had been retained for at least 1 year. Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45 years [adjusted odds ratio (aOR) = 1.75, 95% confidence interval (CI) = 1.64, 1.89], male (aOR = 1.72, 95% CI = 1.64, 1.82), with concurrent substance use disorders (aOR = 2.56, 95% CI = 2.44, 2.70), hepatitis C virus (HCV) (aOR = 1.22, 95% CI = 1.14, 1.33) and either homeless or receiving income-assistance (aOR = 4.35, 95% CI = 4.17, 4.55). Regular contact with the health-care system-either in out-patient or acute care settings-was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.Conclusions People with opioid use disorder in British Columbia, Canada show high levels of out-patient care prior to diagnosis. Younger age, male sex, urban residence, lower income level and homelessness appear to be independently associated with increased opioid agonist treatment engagement.