In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
In Rural Areas, Buprenorphine Waiver Adoption Since 2017 Driven By Nurse Practitioners And Physician Assistants
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DOI：
10.1377/hlthaff.2019.00859
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发表时间：
2019-12-01
期刊：
影响因子：
9.7
通讯作者：
Frank, Richard G.
中科院分区：
文献类型：
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作者：
Barnett, Michael L.;Lee, Dennis;Frank, Richard G.
少数阿片类药物使用障碍患者接受药物成瘾治疗。2017年，《综合成瘾和康复法》使执业护士（NP）和医生助理（PA）能够获得联邦豁免，允许他们开丁丙诺啡，这是阿片类药物使用障碍的关键药物。豁免范围的扩大旨在增加患者获得阿片类药物使用治疗的机会，这对于医生较少的农村地区尤其重要。然而，很少有人知道农村地区的国家警察或保护区是否采用这些豁免。使用联邦数据，我们研究了农村地区的豁免采用及其与实践范围法规的关联，这些法规规定了NP或PA可以开药的程度。从2016年到2019年，农村地区每10万人口中获得豁免的临床医生数量增加了111%。NPs和PA占这一增长的一半以上，是285个农村县570万居民中的第一批豁免临床医生。在农村地区，广泛的实践范围法规与每100，000人口中豁免的NP数量是限制实践范围的两倍。豁免丁丙诺啡的国家警察和公共助理人数的迅速增长是改善农村地区成瘾治疗机会的一个有希望的发展。
Few patients with opioid use disorder receive medication for addiction treatment. In 2017 the Comprehensive Addiction and Recovery Act enabled nurse practitioners (NPs) and physician assistants (PAs) to obtain federal waivers allowing them to prescribe buprenorphine, a key medication for opioid use disorder. The waiver expansion was intended to increase patients' access to opioid use treatment, which was particularly important for rural areas with few physicians. However, little is known about the adoption of these waivers by NPs or PAs in rural areas. Using federal data, we examined waiver adoption in rural areas and its association with scope-of-practice regulations, which set the extent to which NPs or PAs can prescribe medication. From 2016 to 2019 the number of waivered clinicians per 100,000 population in rural areas increased by 111 percent. NPs and PAs accounted for more than half of this increase and were the first waivered clinicians in 285 rural counties with 5.7 million residents. In rural areas, broad scope-of-practice regulations were associated with twice as many waivered NPs per 100,000 population as restricted scopes of practice were. The rapid growth in the numbers of NPs and PAs with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.