Social Determinants of Health and Continuity of Medications for Opioid Use Disorder Among Patients Receiving Treatment in Rural Primary Care Settings.
Social Determinants of Health and Continuity of Medications for Opioid Use Disorder Among Patients Receiving Treatment in Rural Primary Care Settings.
复制标题
在农村初级保健机构接受治疗的患者中阿片类药物使用障碍的健康和持续用药的社会决定因素。
DOI：
10.1097/adm.0000000000001274
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发表时间：
2024
影响因子：
5.5
通讯作者：
Hser,Yih-Ing
中科院分区：
文献类型：
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作者：
Pham,Huyen;Ober,Allison;Baldwin,Laura-Mae;Mooney,LarissaJ;Zhu,Yuhui;Fei,Zhe;Hser,Yih-Ing
在农村地区，阿片类药物使用障碍（MOUD）治疗保留的相关因素知之甚少。本研究探讨社会健康决定因素（SDoH）和MOUD保留阿片类药物使用障碍（OUD）在农村初级保健settings.MethodsWe分析了6个农村诊所的患者电子健康记录之间的关联。参与者（N= 575）为2019年10月至2020年4月期间接受过MOUD治疗的成人患者。MOUD保留率通过MOUD天数来衡量，连续性定义为连续180个MOUD天数，间隔不超过7天。混合效应回归评估的结果和SDoH（医疗保险，社会剥夺指数[SDI]，从家里到诊所的驾驶时间），远程医疗使用，和其他协variators.ResultsMean患者MOUD天之间的关联为127天（SD= 50.7天）。生活在更贫困的地区（基于SDI）（调整后的相对风险[aRR]：0.98; 95%置信区间[CI]，0.98-0.99）和从家到诊所的驾驶时间超过一个小时（相比之下，一个小时或更少）（aRR：0.95; 95% CI，0.93-0.97）与MOUD天数较少相关。使用远程医疗与更多MOUD天数相关（aRR：1.23; 95% CI，1.21-1.26）。在该队列中，21.7%的参与者在MOUD上保留至少180天。SDoH和远程医疗的使用与MOUD.ConclusionsAddressing SDoH（例如，SDI）和提供远程医疗（例如，改善公共交通，互联网接入）的连续性可能会提高MOUD天在农村设置。
ObjectivesFactors associated with treatment retention on medications for opioid use disorder (MOUD) in rural settings are poorly understood. This study examines associations between social determinants of health (SDoH) and MOUD retention among patients with opioid use disorder (OUD) in rural primary care settings.MethodsWe analyzed patient electronic health records from 6 rural clinics. Participants (N= 575) were adult patients with OUD and had any prescription for MOUD from October 2019 to April 2020. MOUD retention was measured by MOUD days and continuity defined as continuous 180 MOUD days with no more than a 7-day gap. Mixed-effect regressions assessed associations between the outcomes and SDoH (Medicaid insurance, social deprivation index [SDI], driving time from home to the clinic), telehealth use, and other covariates.ResultsMean patient MOUD days were 127 days (SD= 50.7 days). Living in more disadvantaged areas (based on SDI)(adjusted relative risk [aRR]: 0.98; 95% confidence interval [CI], 0.98–0.99) and having more than an hour (compared with an hour or less) driving time from home to clinic (aRR: 0.95; 95% CI, 0.93–0.97) were associated with fewer MOUD days. Using telehealth was associated with more MOUD days (aRR: 1.23; 95% CI, 1.21–1.26). In this cohort, 21.7% of the participants were retained on MOUD for at least 180 days. SDoH and use of telehealth were not associated with having continuity of MOUD.ConclusionsAddressing SDoH (eg, SDI) and providing telehealth (eg, improvements in public transportation, internet access) may improve MOUD days in rural settings.