Association between treatment setting and outcomes among oregon medicaid patients with opioid use disorder: a retrospective cohort study.
Association between treatment setting and outcomes among oregon medicaid patients with opioid use disorder: a retrospective cohort study.
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DOI：
10.1186/s13722-022-00318-1
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发表时间：
2022-08-19
影响因子：
3.7
通讯作者：
Korthuis, P. Todd
中科院分区：
文献类型：
--
作者：
Hartung, Daniel M.;Markwardt, Sheila;Johnston, Kirbee;Geddes, Jonah;Baker, Robin;Leichtling, Gillian;Hildebran, Christi;Chan, Brian;Cook, Ryan R.;McCarty, Dennis;Ghitza, Udi;Korthuis, P. Todd
住院治疗是治疗阿片类药物使用障碍（OUD）的常用方法，然而，很少有研究直接将其与门诊治疗进行比较。本研究的目的是比较接受住院治疗和门诊治疗的患者的OUD结果。一项回顾性队列研究使用了来自州医疗补助计划，生命统计数据以及物质滥用和精神卫生服务管理局（SAMHSA）治疗Epidemic数据集（TEDS）的相关数据，以比较2014年至2017年期间在住院或门诊治疗的个人中OUD相关的健康结果。多变量考克斯比例风险和逻辑回归模型检查了治疗设置和结果之间的关联（即，阿片类药物过量、非过量阿片类药物相关和全因急诊（艾德）就诊、住院和治疗保留），控制患者特征、合并症和阿片类药物使用障碍（MOUD）的药物使用。交互模型评估了MOUD如何使用治疗设置和结果之间的修改关联。在接受OUD治疗的3293人中，957人（29%）在住宅设施中接受治疗。MOUD的使用率在门诊患者（43%）中高于住院患者（19%）。阿片类药物过量（aHR 1.39; 95%CI 0.73-2.64）或阿片类药物相关急诊室就诊或入院（aHR 1.02; 95%CI 0.80-1.29）的风险在治疗环境之间没有差异。与环境无关，MOUD使用与药物过量风险显著降低相关（aHR 0.45; 95% CI 0.23-0.89）。住院治疗与6个月时更大的保留几率相关（aOR 1.71; 95%CI 1.32-2.21），但与1年时无关。住院治疗仅与未接受MOUD的个体的保留改善相关（6个月aOR 2.05; 95% CI 1.56-2.71），在接受MOUD的个体中未观察到任何获益（aOR 0.75; 95% CI 0.46-1.29;相互作用p = 0.001）。相对于门诊治疗，住院治疗与阿片类药物过量或阿片类药物相关艾德发作/住院的减少无关。无论如何，MOUD的使用与阿片类药物过量风险的显着降低有关。在线版本包含补充材料，可通过10.1186/s13722-022-00318-1获得。
Residential treatment is a common approach for treating opioid use disorder (OUD), however, few studies have directly compared it to outpatient treatment. The objective of this study was to compare OUD outcomes among individuals receiving residential and outpatient treatment. A retrospective cohort study used linked data from a state Medicaid program, vital statistics, and the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episodes Dataset (TEDS) to compare OUD-related health outcomes among individuals treated in a residential or outpatient setting between 2014 and 2017. Multivariable Cox proportional hazards and logistic regression models examined the association between treatment setting and outcomes (i.e., opioid overdose, non-overdose opioid-related and all-cause emergency department (ED) visits, hospital admissions, and treatment retention) controlling for patient characteristics, co-morbidities, and use of medications for opioid use disorders (MOUD). Interaction models evaluated how MOUD use modified associations between treatment setting and outcomes. Of 3293 individuals treated for OUD, 957 (29%) received treatment in a residential facility. MOUD use was higher among those treated as an outpatient (43%) compared to residential (19%). The risk of opioid overdose (aHR 1.39; 95% CI 0.73–2.64) or an opioid-related emergency department encounter or admission (aHR 1.02; 95% CI 0.80–1.29) did not differ between treatment settings. Independent of setting, MOUD use was associated with a significant reduction in overdose risk (aHR 0.45; 95% CI 0.23–0.89). Residential care was associated with greater odds of retention at 6-months (aOR 1.71; 95% CI 1.32–2.21) but not 1-year. Residential treatment was only associated with improved retention for individuals not receiving MOUD (6-month aOR 2.05; 95% CI 1.56–2.71) with no benefit observed in those who received MOUD (aOR 0.75; 95% CI 0.46–1.29; interaction p = 0.001). Relative to outpatient treatment, residential treatment was not associated with reductions in opioid overdose or opioid-related ED encounters/hospitalizations. Regardless of setting, MOUD use was associated with a significant reduction in opioid overdose risk. The online version contains supplementary material available at 10.1186/s13722-022-00318-1.
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影响因子：
13.8
作者：
Huhn AS;Hobelmann JG;Strickland JC;Oyler GA;Bergeria CL;Umbricht A;Dunn KE
通讯作者：
Dunn KE
影响因子：
5.7
作者：
Hartung, Daniel M.;Johnston, Kirbee A.;Korthuis, P. Todd
通讯作者：
Korthuis, P. Todd
影响因子：
3
作者：
Moore, Brian J.;White, Susan;Elixhauser, Anne
通讯作者：
Elixhauser, Anne
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
3.9
作者：
Mark, Tami L.;Vandivort-Warren, Rita;Montejano, Leslie B.
通讯作者：
Montejano, Leslie B.