Impact of COVID-19-related regulatory changes on nationwide access to buprenorphine: An interrupted time series design.
Impact of COVID-19-related regulatory changes on nationwide access to buprenorphine: An interrupted time series design.
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DOI：
10.1016/j.dadr.2023.100135
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发表时间：
2023-03
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影响因子：
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通讯作者：
Liebschutz, Jane M
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作者：
Roy, Payel Jhoom;Callaway Kim, Katherine;Suda, Katie;Luo, Jing;Wang, Xiaoming;Olejniczak, Donna;Liebschutz, Jane M
患者接受了更长时间的丁丙诺啡处方。总体而言，丁丙诺啡总毫克数在最初大流行后增加。治疗稳定的患者经历的治疗中断较少。医疗补助患者获得丁丙诺啡的机会有所改善。监管方面的变化似乎帮助患者维持了丁丙诺啡的使用。新冠肺炎相关的医疗保健变化对美国全国范围内获得丁丙诺啡(BUP)的影响尚不清楚。我们用IQVIA LRx数据库进行了中断的时间序列。研究时间线包括从最初流行期(2/22/20-4/3/20)前52周(2/23/19-2/21)至52周(4/4/20-4/2/20)的BUP处方。分段回归估计在初始大流行后1、26和52周全国范围内每周可用BUP的总毫克(MG)的相对变化。我们评估了以前稳定的患者的治疗中断，定义为≥6个月的BUP处方。共有31 617 849张处方纳入研究。MG BUP分配总量在第1周和第26周增加，然后在最初大流行后52周恢复到基线趋势(4.1%[95%CI：3.7，4.5]，2.1%[1.5，2.6]，0.1%[-0.6，0.9])。接受稳定治疗的患者在最初大流行后52周的7、14和28天治疗中断减少(-21.6%[-25.6，-17.7]；-10.8%[-16.3，-5.3]；-27.3%[-33.0，-21.6])。52周时，男性MG BUP较女性增加(0.7%[0.01，1.4]对-0.6%[-1.5，0.2])。与预期基线趋势(-16.6[-24.2，-9.0]；-1.6[-3.0，-0.1])相比，年轻年龄组(18-29岁和30-39岁)52周时MG BUP下降。接受医疗补助的患者52周时MG BUP增加(8.3%[6.3，10.3])。在大流行前，APP处方开出的mg BUP每周增加超过14万mg，而且还在继续增加。在大流行期间，围绕丁丙诺啡处方的监管变化为患者获得丁丙诺啡提供了便利。
Patients received longer prescriptions of buprenorphine. Overall total milligrams buprenorphine increased post-initial pandemic period. Stably-treated patients experienced fewer treatment disruptions. Medicaid patients had improved access to buprenorphine. Regulatory changes appear to have helped patients maintain access to buprenorphine. The impact of COVID-19-related healthcare changes on access to buprenorphine (BUP) nationwide in the US is unknown. We conducted an interrupted time series with the IQVIA LRx database. The study timeline included BUP prescriptions from 52 weeks before (2/23/19–2/21/20) to 52 weeks after (4/4/20–4/2/21) the initial pandemic period (2/22/20–4/3/20). Segmented regression estimated relative changes in total milligrams (MG) of BUP available per week nationwide at 1, 26, and 52 weeks post-initial-pandemic. We evaluated treatment disruptions in previously stable patients, defined as ≥6 months of BUP prescriptions. A total of 31 617 849 prescriptions were included. Total MG BUP dispensed increased at 1 and 26 weeks and then returned to baseline trends at 52 weeks post-initial pandemic period (4.1% [95% CI: 3.7,4.5], 2.1% [1.5,2.6], 0.1% [-0.6,0.9]). Stably-treated patients saw a decrease in 7-, 14-, and 28-day treatment disruptions at 52 weeks post-initial-pandemic period (-21.6% [-25.6,-17.7]; -10.8% [-16.3,-5.3]; -27.3% [-33.0,-21.6]). Men retained an increase in MG BUP compared to women at 52 weeks (0.7% [0.01,1.4] versus -0.6% [-1.5,0.2]). Younger age groups (18–29 years and 30–39 years) had a decrease in MG BUP at 52 weeks compared to expected baseline trend (-16.6 [-24.2, -9.0]; -1.6 [-3.0, -0.1). Patients with Medicaid demonstrated an increase in MG BUP at 52 weeks (8.3% [6.3,10.3]). MG BUP prescribed by APP prescribing increased by over 140 000 mg per week prior to the pandemic and continued to increase. Regulatory changes around buprenorphine prescribing facilitated patient access to buprenorphine during the pandemic.