Buprenorphine prescriber monthly patient caseloads: An examination of 6-year trajectories.
Buprenorphine prescriber monthly patient caseloads: An examination of 6-year trajectories.
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DOI：
10.1016/j.drugalcdep.2021.109089
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发表时间：
2021-11-01
影响因子：
4.2
通讯作者：
Stein BD
中科院分区：
文献类型：
--
作者：
Cabreros I;Griffin BA;Saloner B;Gordon AJ;Kerber R;Stein BD
许多活跃的丁丙诺啡处方者每月治疗的患者很少，但关于处方者丁丙诺啡病例量如何随时间波动或新处方者需要多长时间才能达到更高的患者病例量的信息很少。我们研究了丁丙诺啡处方临床医生的患者病例量随时间的推移，并探讨了与不同病例量轨迹相关的处方者特征。使用2006-2018年国家丁丙诺啡药房索赔，我们计算了临床医生首次服用丁丙诺啡处方后6年内丁丙诺啡处方者每月的患者病例量。我们使用k均值聚类来确定临床医生病例负荷轨迹的聚类，并使用双变量分析来检查与不同轨迹类别相关的处方者和县特征。我们确定了42067名丁丙诺啡处方者，分为3类。高容量（1.4%,n=571），在最初的20个月，平均每月患者病例量增加到约40例，并稳定在40例或更多；中等数量（9.2%;n=3,891），其平均病例量在最初20个月内增加，稳定在15至20例；低容量（89.4%;n=37,605），通常每月患者少于5例。大多数小剂量开处方者（n=31,470，占所有开处方者的83.7%）最初治疗1-2例患者数月，随后不再开处方。几乎四分之三的丁丙诺啡处方者在停止丁丙诺啡处方前治疗的患者不超过几个月；在接下来的6年里，只有10%的开处方者平均每月给10个以上的病人开处方。需要努力确定导致开处方者愿意长期继续开丁丙诺啡的因素，并为更多的患者开处方，以增加丁丙诺啡治疗的可及性。
Many active buprenorphine prescribers treat few patients monthly, but little information is available regarding how prescribers’ buprenorphine caseload fluctuates over time or how long it takes new prescribers to reach higher patient caseloads. We examine buprenorphine-prescribing clinicians’ patient caseloads over time and explore prescriber characteristics associated with different caseload trajectories. Using 2006–2018 national buprenorphine pharmacy claims, we calculate monthly patient caseloads for buprenorphine prescribers for 6 years following a clinician’s first filled buprenorphine prescription. We use K-means clustering to identify clusters of clinician caseload trajectories and bivariate analyses to examine prescriber and county characteristics associated with different trajectory classes. We identified 42,067 buprenorphine prescribers with 3 trajectory classes. High-volume (1.4%;n=571) whose mean monthly patient caseload increased to approximately 40 patients through the initial 20 months and stabilized at 40 or more patients; moderate-volume (9.2%;n=3,891) whose mean patient caseload increased during the initial 20 months, stabilizing at 15 to 20 patients; and low-volume (89.4%;n=37,605), who typically had fewer than 5 patients monthly. Most low-volume prescribers (n=31,470; 83.7% of all prescribers) initially treated 1–2 patients for several months, followed by no subsequent prescribing. Almost three-quarters of buprenorphine prescribers treated no more than a few patients for several months before ceasing buprenorphine prescribing; only 10% of prescribers averaged more than 10 patients per month over the next 6 years. Efforts are needed to identify factors contributing to prescribers being willing to continue prescribing buprenorphine over time and to prescribe to more patients in order to increase access to buprenorphine treatment.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
3.7
作者：
Hagedorn, Hildi;Kenny, Marie;Harris, Alex H. S.
通讯作者：
Harris, Alex H. S.
影响因子：
3.5
作者：
Meinhofer, Angelica;Witman, Allison E.
通讯作者：
Witman, Allison E.
影响因子：
3.9
作者：
Miele, Gloria M.;Caton, Lauren;Rawson, Richard
通讯作者：
Rawson, Richard
影响因子：
3.9
作者：
Norton, B. L.;Beitin, A.;Cunningham, C. O.
通讯作者：
Cunningham, C. O.