Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients
Incidence of Treatment for Opioid Use Disorder Following Nonfatal Overdose in Commercially Insured Patients
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DOI：
10.1001/jamanetworkopen.2020.5852
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发表时间：
2020-05-27
影响因子：
13.8
通讯作者：
Delgado, Kit
中科院分区：
文献类型：
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作者：
Kilaru, Austin S.;Xiong, Aria;Delgado, Kit
重要性及时启动和转诊治疗阿片类药物使用障碍的患者在急诊科看到与死亡率降低。目前尚不清楚有商业保险的成年人在非致命性阿片类药物过量后获得后续治疗的频率。目的探讨非致死性阿片类药物过量后急诊出院后随访治疗的发生率以及与接受随访治疗相关的患者特征。设计、设置和参与者：一项回顾性队列研究，使用美国一家大型商业保险公司的行政索赔数据库，从2011年10月1日至2016年9月30日进行。数据分析于2019年5月1日至2019年9月26日进行。纳入了指数阿片类药物过量（前90天内无过量）后从急诊科出院的成人患者。癌症患者和没有连续保险登记的患者被排除在外。主要结局和测量主要结局是过量后90天内的随访治疗，定义为治疗遭遇或阿片类药物使用障碍（丁丙诺啡和纳洛酮）的索赔的组合结局。分析按患者在用药过量前90天内是否接受阿片类药物使用障碍治疗进行分层。Logistic回归模型用于识别与接受随访治疗相关的患者特征。边际效应用于报告不同患者特征随访中的平均调整概率和绝对风险差异（ARDs）。结果：共有6451例患者被确定为非致死性阿片类药物过量;平均（SD）年龄为45.0（19.3）岁，3267例为女性（50.6%），4676例患者（72.5%）报告其种族为非西班牙裔白色。共有1069例患者（16.6%; 95% CI，15.7%-17.5%）在药物过量后90天内接受了随访治疗。在对用药过量前未接受治疗的患者进行的校正分析中，黑人患者获得随访的可能性是非西班牙裔白色患者的一半（ARD，-5.9%; 95% CI，-8.6%至-3.6%）。女性（ARD，-1.7%; 95% CI，-3.3%至-0.5%）和西班牙裔患者（ARD，-3.5%; 95% CI，-6.1%至-0.9%）获得随访的可能性也较低。年龄每增加一岁，患者获得随访的可能性降低0.2%（95% CI，-0.3%至-0.1%）。结论和相关性努力提高阿片类药物过量后及时随访治疗率低，可能会寻求解决性别，种族/民族，和年龄差异。问题有商业保险的患者多久获得后续治疗阿片类药物使用障碍后，非致命性阿片类药物过量？在这项针对6451名患者的国家商业保险索赔的队列研究中，16.6%的患者在非致命性阿片类药物过量后获得了随访治疗。在过量用药前未接受阿片类药物使用障碍治疗的患者中，年龄较大、女性、黑人和西班牙裔的患者不太可能获得随访。在商业保险患者中，阿片类药物过量后及时治疗阿片类药物使用障碍的比例似乎很低，种族/民族，性别和年龄差异。
Importance Timely initiation and referral to treatment for patients with opioid use disorder seen in the emergency department is associated with reduced mortality. It is not known how often commercially insured adults obtain follow-up treatment after nonfatal opioid overdose. Objective To investigate the incidence of follow-up treatment following emergency department discharge after nonfatal opioid overdose and patient characteristics associated with receipt of follow-up treatment. Design, Setting, and Participants A retrospective cohort study was conducted using an administrative claims database for a large US commercial insurer, from October 1, 2011, to September 30, 2016. Data analysis was performed from May 1, 2019, to September 26, 2019. Adult patients discharged from the emergency department after an index opioid overdose (no overdose in the preceding 90 days) were included. Patients with cancer and without continuous insurance enrollment were excluded. Main Outcomes and Measures The primary outcome was follow-up treatment in the 90 days following overdose, defined as a combined outcome of claims for treatment encounters or medications for opioid use disorder (buprenorphine and naltrexone). Analysis was stratified by whether patients received treatment for opioid use disorder in the 90 days before the overdose. Logistic regression models were used to identify patient characteristics associated with receipt of follow-up treatment. Marginal effects were used to report the average adjusted probability and absolute risk differences (ARDs) in follow-up for different patient characteristics. Results A total of 6451 patients were identified with nonfatal opioid overdose; the mean (SD) age was 45.0 (19.3) years, 3267 were women (50.6%), and 4676 patients (72.5%) reported their race as non-Hispanic white. A total of 1069 patients (16.6%; 95% CI, 15.7%-17.5%) obtained follow-up treatment within 90 days after the overdose. In adjusted analysis of patients who did not receive treatment before the overdose, black patients were half as likely to obtain follow-up compared with non-Hispanic white patients (ARD, -5.9%; 95% CI, -8.6% to -3.6%). Women (ARD, -1.7%; 95% CI, -3.3% to -0.5%) and Hispanic patients (ARD, -3.5%; 95% CI, -6.1% to -0.9%) were also less likely to obtain follow-up. For each additional year of age, patients were 0.2% less likely to obtain follow-up (95% CI, -0.3% to -0.1%). Conclusions and Relevance Efforts to improve the low rate of timely follow-up treatment following opioid overdose may seek to address sex, race/ethnicity, and age disparities.Question How often do commercially insured patients obtain follow-up treatment for opioid use disorder after a nonfatal opioid overdose? Findings In this cohort study of national commercial insurance claims for 6451 patients, 16.6% of patients obtained follow-up treatment after a nonfatal opioid overdose. Among those who had not received treatment for opioid use disorder before the overdose, patients of older age, female sex, black race, and Hispanic ethnicity were less likely to obtain follow-up. Meaning Timely treatment for opioid use disorder following overdose appears to be low among commercially insured patients, with race/ethnicity, sex, and age disparities.This cohort study examines the use of follow-up treatment by patients who experience heroin or prescription opioid overdose.