The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources
The Transition to Medication Adoption in Publicly Funded Substance Use Disorder Treatment Programs: Organizational Structure, Culture, and Resources
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DOI：
10.15288/jsad.2014.75.476
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发表时间：
2014-05-01
影响因子：
3.4
通讯作者：
Roman, Paul M.
中科院分区：
文献类型：
--
作者：
Knudsen, Hannah K.;Roman, Paul M.
目的：在公共资助的物质使用障碍（SUD）治疗项目中，用于治疗SUD的药物并不广泛。很少有研究利用纵向数据来检查与从不提供任何药物治疗过渡到采用至少一种SUD药物的项目相关的组织特征。方法：使用在5年期间收集的两波面板纵向数据，我们测量了在基线时不提供SUD药物的190个公共资助的治疗组织的队列中向药物采用的过渡。自变量包括组织特征，医疗资源，资金，治疗文化，并详细说明制药公司的活动。结果如下：在基线时不提供SUD药物治疗的190个项目中，22.6%在大约5年后的随访时过渡到提供至少一种SUD药物。多变量logistic回归结果表明，在基线时至少雇用一名医生，有更大比例的医疗补助客户，以及药品详细说明与药物采用呈正相关。结论：采用药物治疗更有可能在项目中有更多的医疗资源，医疗补助资金，并与制药公司联系。鉴于《平价医疗法案》下医疗补助的潜在扩展，公共资助项目服务的患者可能会获得更多的此类治疗，但需要进行研究以记录医疗改革对治疗系统这一部门的影响。
Objective: Medications for the treatment of substance use disorders (SUDs) are not widely available in publicly funded SUD treatment programs. Few studies have drawn on longitudinal data to examine the organizational characteristics associated with programs transitioning from not delivering any pharmacotherapy to adopting at least one SUD medication. Method: Using two waves of panel longitudinal data collected over a 5-year period, we measured the transition to medication adoption in a cohort of 190 publicly funded treatment organizations that offered no SUD medications at baseline. Independent variables included organizational characteristics, medical resources, funding, treatment culture, and detailing activities by pharmaceutical companies. Results: Of 190 programs not offering SUD pharmacotherapy at baseline, 22.6% transitioned to offering at least one SUD medication at follow-up approximately 5 years later. Multivariate logistic regression results indicated that the employment of at least one physician at baseline, having a greater proportion of Medicaid clients, and pharmaceutical detailing were positively associated with medication adoption. Conclusions: Adoption of pharmacotherapy was more likely in programs that had greater medical resources, Medicaid funding, and contact with pharmaceutical companies. Given the potential expansion of Medicaid under the Affordable Care Act, patients served by publicly funded programs may gain greater access to such treatments, but research is needed to document health reform's impact on this sector of the treatment system.