Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder
Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder
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DOI：
10.1111/add.14436
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发表时间：
2019-03-01
期刊：
影响因子：
6
通讯作者：
McCance-Katz, Elinore F.
中科院分区：
文献类型：
--
作者：
Jones, Christopher M.;McCance-Katz, Elinore F.
背景和目的扩大丁丙诺啡药物辅助治疗的可及性是阿片类药物危机应对的基石，但丁丙诺啡仍未得到充分利用。研究已经确定了开丁丙诺啡的多种障碍。本研究旨在检查临床医生的特征、处方实践以及在2000年联邦药物成瘾治疗法案（DATA）豁免处方丁丙诺啡用于阿片类药物使用障碍治疗的临床医生中处方丁丙诺啡的障碍和激励。设计2018年3月至4月期间对4225名临床医生进行的电子调查。设置美国。参与者临床医生获得初始联邦数据豁免或增加授权患者限制，以在2017年处方丁丙诺啡用于阿片类药物使用障碍治疗。测量描述性统计和多变量逻辑回归检查临床医生的特点，处方的做法和主要障碍和激励，以处方丁丙诺啡或处方或接近授权的患者限制。结果在受访者中，75.5%的人自获得DATA豁免以来处方了丁丙诺啡;在过去一个月接受治疗的患者的平均数（标准差）为26.6（40.3），13.1%的供应商在过去一个月内处方或接近其患者限制。19.4%的临床医生指出，缺乏患者需求是开丁丙诺啡或按授权患者限额开药的最常见主要障碍，其次是实践中的时间限制（14.6%）和保险报销、事先授权或其他保险要求（13.2%）。患者需求增加（22.2%）、对丁丙诺啡治疗的机构支持（12.5%）和报销增加（12.2%）是丁丙诺啡处方最受认可的主要激励因素。多变量逻辑回归模型确定了与丁丙诺啡处方和在授权患者限值或附近处方相关的多个临床医生特征。结论：美国临床医生最近放弃为阿片类药物使用障碍治疗开丁丙诺啡的处方似乎远低于他们的患者限制，许多人根本不开处方。
Background and Aims Expanding access to medication-assisted treatment with buprenorphine is a cornerstone of the opioid crisis response, yet buprenorphine remains underutilized. Research has identified multiple barriers to prescribing buprenorphine. This study aimed to examine clinician characteristics, prescribing practices and barriers and incentives to prescribing buprenorphine among clinicians with a federal Drug Addiction Treatment Act of 2000 (DATA) waiver to prescribe buprenorphine for opioid use disorder treatment. Design Electronic survey of 4225 clinicians conducted between March and April 2018. Setting United States. Participants Clinicians obtaining an initial federal DATA waiver or an increase in authorized patient limit to prescribe buprenorphine for opioid use disorder treatment in 2017. Measurements Descriptive statistics and multivariable logistic regression examined clinician characteristics, prescribing practices and primary barriers and incentives to prescribing buprenorphine or prescribing at or near the authorized patient limit. Findings Among respondents, 75.5% had prescribed buprenorphine since obtaining a DATA waiver; the mean (standard deviation) number of patients treated in the past month was 26.6 (40.3), and 13.1% of providers were prescribing at or near their patient limit in the past month. Lack of patient demand, cited by 19.4% of clinicians, was the most common primary barrier to prescribing buprenorphine or prescribing to the authorized patient limit, followed by time constraints in practice (14.6%) and insurance reimbursement, prior authorization or other insurance requirements (13.2%). Increased patient demand (22.2%), institutional support for buprenorphine treatment (12.5%) and increased reimbursement (12.2%) were the most endorsed primary incentives for buprenorphine prescribing. Multivariable logistic regression models identified multiple clinician characteristics associated with buprenorphine prescribing and prescribing at or near the authorized patient limit. Conclusions US clinicians recently waivered to prescribe buprenorphine for opioid use disorder treatment appear to prescribe well below their patient limit, and many do not prescribe at all.