Impact Of Long-Term Buprenorphine Treatment On Adverse Health Care Outcomes In Medicaid.
Impact Of Long-Term Buprenorphine Treatment On Adverse Health Care Outcomes In Medicaid.
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DOI：
10.1377/hlthaff.2019.01085
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发表时间：
2020-05
期刊：
影响因子：
--
通讯作者：
Olfson M
中科院分区：
文献类型：
--
作者：
Samples H;Williams AR;Crystal S;Olfson M
改善长期结果所需的阿片使用障碍(OUD)药物治疗的最佳甚至最短持续时间尚未从经验上确定。因此，医疗计划设定了可能具有限制性的治疗标准，以指导福利和支付。为了解决这一差距，我们使用了国家质量论坛对药物治疗持续时间(180天)的衡量标准，以检查较长时间的治疗对医疗补助参与者关键人群中的医疗保健结果的影响。与国家质量论坛基准(6至9个月)附近的丁丙诺啡停用相比，较长的治疗(至少15个月)与全原因住院患者(−52%)和急诊科(−26%)使用风险、与阿片类药物相关的医院使用(−128%)、过量事件(−173%)和阿片类药物处方(−120%)以及处方阿片类药物使用率(−124%)的相对降低相关。我们认为，这些临床益处为增加丁丙诺啡长期治疗机会的政策提供了理由，包括延长最短治疗时间的标准。
The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, we used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees. Compared to buprenorphine discontinuation around the National Quality Forum benchmark (six to nine months), longer treatment (at least fifteen months) was associated with relative reductions in the risk of having all-cause inpatient (−52 percent) and emergency department (−26 percent) use, opioid-related hospital use (−128 percent), overdose events (−173 percent), and opioid prescriptions (−120 percent) and in the rate of prescription opioid use (−124 percent). We argue that these clinical benefits provide a rationale for policies that increase access to longer-term buprenorphine treatment, including lengthening the standards for minimum treatment duration.
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