Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network
Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network
复制标题
DOI：
10.1016/j.jsat.2019.11.008
复制
发表时间：
2020-03-01
影响因子：
3.9
通讯作者：
Stephens, Kari A.
中科院分区：
文献类型：
--
作者：
Hallgren, Kevin A.;Witwer, Elizabeth;Stephens, Kari A.
背景：大多数患有酒精或阿片类药物使用障碍（AUD 或 OUD）的人并未在初级保健中诊断或治疗这些疾病。这项研究通过使用来自不同初级保健组织的电子健康记录 (EHR) 数据来量化 AUD 和 OUD 在初级保健实践中诊断不足和治疗不足的程度，朝着量化服务差距和指导 AUD 和 OUD 的改进工作迈出了关键的一步。方法：我们从代表社区健康的四个独立医疗保健组织内 21 个初级保健诊所的 EHR 中提取并整合了诊断、药物和行为健康就诊数据 美国西北太平洋地区的中心和乡村医院相关诊所。对两年（2015-2016）期间记录的 AUD 和 OUD 诊断、药物治疗和行为健康就诊率进行了评估。结果：在 47,502 名成人初级保健患者中，1476 名（3.1%）记录了 AUD；其中，115 人 (7.8%) 订购了澳元药物，271 人 (18.4%) 至少接受过一次非医生行为健康专家的有记录的就诊。只有 402 名 (0.8%) 患者记录了 OUD，其中 107 名 (26.6%) 患者接受了 OUD 药物治疗，119 名 (29.6%) 患者至少接受过一次非医生行为健康专家的就诊记录。在拥有非医生行为健康专家的诊所中，AUD 诊断率以及 AUD 和 OUD 药物治疗率较高。结论：在主要为农村患者提供服务的独立初级保健组织样本中，AUD 和 OUD 的诊断和治疗不足。初级保健组织可能需要服务模式、技术和劳动力（包括非医师行为健康专家）来提高诊断和治疗 AUD 和 OUD 的能力。
Background: Most people with alcohol or opioid use disorders (AUD or OUD) are not diagnosed or treated for these conditions in primary care. This study takes a critical step toward quantifying service gaps and directing improvement efforts for AUD and OUD by using electronic health record (EHR) data from diverse primary care organizations to quantify the extent to which AUD and OUD are underdiagnosed and undertreated in primary care practices.Methods: We extracted and integrated diagnosis, medication, and behavioral health visit data from the EHRs of 21 primary care clinics within four independent healthcare organizations representing community health centers and rural hospital-associated clinics in the Pacific Northwest United States. Rates of documented AUD and OUD diagnoses, pharmacological treatments, and behavioral health visits were evaluated over a two-year period (2015-2016).Results: Out of 47,502 adult primary care patients, 1476 (3.1%) had documented AUD; of these, 115 (7.8%) had orders for AUD medications and 271 (18.4%) had at least one documented visit with a non-physician behavioral health specialist. Only 402 (0.8%) patients had documented OUD, and of these, 107 (26.6%) received OUD medications and 119 (29.6%) had at least one documented visit with a non-physician behavioral health specialist. Rates of AUD diagnosis and AUD and OUD medications were higher in clinics that had co-located non-physician behavioral health specialists.Conclusions: AUD and OUD are underdiagnosed and undertreated within a sample of independent primary care organizations serving mostly rural patients. Primary care organizations likely need service models, technologies, and workforces, including non-physician behavioral health specialists, to improve capacities to diagnose and treat AUD and OUD.