Prevalence and treatment of opioid use disorders among primary care patients in six health systems
Prevalence and treatment of opioid use disorders among primary care patients in six health systems
复制标题
DOI：
10.1016/j.drugalcdep.2019.107732
复制
发表时间：
2020-02-01
影响因子：
4.2
通讯作者：
Zare, Mohammad
中科院分区：
文献类型：
--
作者：
Lapham, Gwen;Boudreau, Denise M.;Zare, Mohammad
背景：2017年，美国经历了近4.8万例阿片类药物过量死亡。用丁丙诺啡治疗阿片使用障碍(OUD)是推荐的初级保健的一部分，但人们对美国目前在这方面的做法知之甚少。这项观察性研究报告了六个大型卫生系统的初级保健患者中有记录的OUD和使用丁丙诺啡的OUD治疗的流行率。方法：纳入在六个卫生系统的三年期间(2013年10月1日-2016年9月30日)有2次初级保健就诊的成年人。数据来自电子健康记录和索赔数据，以及三年期间评估的措施，包括ICD 9和10代码记录的OUD指标和丁丙诺啡OUD治疗。结果：在1,368,604名初级保健患者中，13,942人(1.0%)有OUD记录，其中21.0%的人曾使用丁丙诺啡进行OUD治疗。对于记录在案的OUD患者，丁丙诺啡治疗OUD的调整流行率因人口统计和临床亚组而异。在年龄较大、女性、黑人/非裔美国人和西班牙裔(与白人相比)、没有商业保险、有非癌症疼痛、精神健康障碍、合并疾病较多、更多阿片类药物处方、急诊科就诊或住院的患者中，OUD治疗较低。结论：在六个卫生系统的初级保健患者中，五分之一的OUD患者使用丁丙诺啡治疗，在人口统计学和临床特征上存在差异。在急性护理利用率较高的患者中，丁丙诺啡治疗较少，这突显了系统水平变化增加OUD治疗的机会。
Background: The U.S. experienced nearly 48,000 opioid overdose deaths in 2017. Treatment of opioid use disorder (OUD) with buprenorphine is a recommended part of primary care, yet little is known about current U.S. practices in this setting. This observational study reports the prevalence of documented OUD and OUD treatment with buprenorphine among primary care patients in six large health systems.Methods: Adults with >= 2 primary care visits during a three-year period (10/1/2013-9/30/2016) in six health systems were included. Data were obtained from electronic health record and claims data, with measures, assessed over the three-year period, including indicators for documented OUD from ICD 9 and 10 codes and OUD treatment with buprenorphine. The prevalence of OUD treatment was adjusted for age, gender, race/ethnicity, and health system.Results: Among 1,368,604 primary care patients, 13,942 (1.0 %) had documented OUD, and among these, 21.0 % had OUD treatment with buprenorphine. For those with documented OUD, the adjusted prevalence of OUD treatment with buprenorphine varied across demographic and clinical subgroups. OUD treatment was lower among patients who were older, women, Black/African American and Hispanic (compared to white), noncommercially insured, and those with non-cancer pain, mental health disorders, greater comorbidity, and more opioid prescriptions, emergency department visits or hospitalizations.Conclusions: Among primary care patients in six health systems, one in five with an OUD were treated with buprenorphine, with disparities across demographic and clinical characteristics. Less buprenorphine treatment among those with greater acute care utilization highlights an opportunity for systems-level changes to increase OUD treatment.