Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities.
Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities.
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DOI：
10.1007/s11606-023-08027-4
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发表时间：
2023-06
影响因子：
5.7
通讯作者：
Lovejoy, Travis I. I.
中科院分区：
文献类型：
--
作者：
Wyse, Jessica J. J.;Shull, Sarah;Lindner, Stephan;Morasco, Benjamin J. J.;Gordon, Adam J. J.;Carlson, Kathleen F. F.;Korthuis, P. Todd;Ono, Sarah S. S.;Liberto, Joseph G. G.;Lovejoy, Travis I. I.
对于阿片类药物使用障碍（OUD）患者，OUD药物（MOUD）可降低发病率，死亡率和恢复使用。然而，只有少数病人接受MOUD，农村病人的利用率明显不足。虽然退伍军人健康管理局（VHA）的举措改善了MOUD的整体访问，但目前尚不清楚是否在农村VA卫生系统中有所改善。“社区护理”，即由VHA支付但从非VA提供者那里获得的医疗保健，如何影响农村的获得也是未知的。本观察性研究的数据来自VHA公司数据仓库。设施乡村性定义为基层医疗中心的城乡通勤区域代码。国际疾病分类编码确定了2015-2020年每年的OUD患者。我们包括MOUD（丁丙诺啡，美沙酮，缓释纳洛酮）从VHA收到或由VHA支付，但通过社区护理在非VA设施收到。我们计算了平均每年MOUD接收;线性回归的研究年的结果确定的趋势;年和农村状态之间的相互作用评估随着时间的推移趋势的差异。所有129个VHA卫生系统，包括一个或多个医疗中心及其附属的社区门诊诊所的指定诊断为OUD的患者在农村与城市VHA卫生保健系统中接受MOUD的平均比例。从2015年到2020年，MOUD的可及性大幅增加：接受MOUD治疗的患者平均比例从34.6%增加到48.9%，所有年份农村和城市系统接受MOUD治疗的患者比例相似。总体而言，一小部分（1.8%）的MOUD是通过社区护理提供的，社区护理并没有不成比例地使农村卫生系统受益。VHA使用的策略可以告知其他医疗保健系统，以确保无论地理位置如何，所有患者都能够访问MOUD。在线版本包含补充材料，可通过10.1007/s11606-023-08027-4获得。
For patients with opioid use disorder (OUD), medications for OUD (MOUD) reduce morbidity, mortality, and return to use. Nevertheless, a minority of patients receive MOUD, and underutilization is pronounced among rural patients. While Veterans Health Administration (VHA) initiatives have improved MOUD access overall, it is unknown whether access has improved in rural VA health systems specifically. How “Community Care,” healthcare paid for by VHA but received from non-VA providers, has affected rural access is also unknown. Data for this observational study were drawn from the VHA Corporate Data Warehouse. Facility rurality was defined by rural-urban commuting area code of the primary medical center. International Classification of Diseases codes identified patients with OUD within each year, 2015–2020. We included MOUD (buprenorphine, methadone, extended-release naltrexone) received from VHA or paid for by VHA but received at non-VA facilities through Community Care. We calculated average yearly MOUD receipt; linear regression of outcomes on study years identified trends; an interaction between year and rural status evaluated trend differences over time. All 129 VHA Health Systems, a designation that encompasses one or more medical centers and their affiliated community-based outpatient clinics The average proportion of patients diagnosed with OUD that receive MOUD within rural versus urban VHA health care systems. From 2015 to 2020, MOUD access increased substantially: the average proportion of patients receiving MOUD increased from 34.6 to 48.9%, with a similar proportion of patients treated with MOUD in rural and urban systems in all years. Overall, a small proportion (1.8%) of MOUD was provided via Community Care, and Community Care did not disproportionately benefit rural health systems. Strategies utilized by VHA could inform other health care systems seeking to ensure that, regardless of geographic location, all patients are able to access MOUD. The online version contains supplementary material available at 10.1007/s11606-023-08027-4.
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影响因子：
3.9
作者：
Brothers, Sarah;Viera, Adam;Heimer, Robert
通讯作者：
Heimer, Robert
影响因子：
4.2
作者：
Lagisetty P;Garpestad C;Larkin A;Macleod C;Antoku D;Slat S;Thomas J;Powell V;Bohnert ASB;Lin LA
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Lin LA
影响因子：
3.7
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Hawkins EJ;Danner AN;Malte CA;Blanchard BE;Williams EC;Hagedorn HJ;Gordon AJ;Drexler K;Burden JL;Knoeppel J;Lott A;Sayre GG;Midboe AM;Saxon AJ
通讯作者：
Saxon AJ
影响因子：
3.7
作者：
Wyse, Jessica J.;Mackey, Katherine;Lovejoy, Travis, I;Kansagara, Devan;Tuepker, Anais;Gordon, Adam J.;Korthuis, P. Todd;Herreid-O'Neill, Anders;Williams, Beth;Morasco, Benjamin J.
通讯作者：
Morasco, Benjamin J.
影响因子：
2.7
作者：
DeRonne, Beth M.;Wong, Kara R.;Krebs, Erin E.
通讯作者：
Krebs, Erin E.