Patterns and Quality of Buprenorphine Opioid Agonist Treatment in a Large Medicaid Program
Patterns and Quality of Buprenorphine Opioid Agonist Treatment in a Large Medicaid Program
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DOI：
10.1097/adm.0000000000000164
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发表时间：
2015-11-01
影响因子：
5.5
通讯作者：
Donohue, Julie M.
中科院分区：
文献类型：
--
作者：
Gordon, Adam J.;Lo-Ciganic, Wei-Hsuan;Donohue, Julie M.
目标：丁丙诺啡（一种治疗阿片类药物使用障碍 (OUD) 的有效方法）的使用近年来迅速增加，并且通常由医疗补助资助。我们在一个大型州医疗补助计划中调查了丁丙诺啡治疗、护理模式和护理质量的预测因素。方法：2007 年至 2012 年宾夕法尼亚州医疗补助的数据提供了有关诊断、人口特征、登记以及住院和门诊服务以及处方药使用的信息。我们确定了使用丁丙诺啡的成年参与者，并检查了 OUD 诊断的流行率、使用模式（持续时间和剂量）和护理质量（医生就诊、接受行为健康咨询、尿液药物筛查和其他处方药使用）。我们使用混合逻辑回归模型来检查与丁丙诺啡使用相关的登记者特征。结果：从 2007 年到 2012 年，使用 OUD 填写丁丙诺啡处方的登记者比例从 2985 名 (9.8%) 增加到 12,691 名 (25.2%)。使用丁丙诺啡的登记者中有 26.2% 至 32.0% 没有诊断出 OUD，取决于年份。在使用丁丙诺啡的参与者中，只有 60.1% 接受过至少一次尿液药物筛查，41.0% 的参与者接受过行为健康咨询服务，34.7% 和 38.0% 的参与者分别在使用丁丙诺啡的同时声称有其他阿片类药物和苯二氮卓类药物。没有 OUD 诊断记录的患者的护理质量较低。丁丙诺啡的平均每日剂量随着时间的推移而减少。我们发现 OUD 患者使用丁丙诺啡的可能性因年龄、性别和种族而存在很大差异。 结论：随着时间的推移，医疗补助人群中丁丙诺啡治疗的增加有所增加；然而，增长因年龄、性别和比率而异，而且所接受的护理质量似乎普遍较差。应进一步探讨医疗补助人群中丁丙诺啡治疗的质量。
Objectives: Use of buprenorphine - an effective treatment for opioid use disorders (OUDs) - has increased rapidly in recent years and is often financed by Medicaid. We investigated predictors of buprenorphine treatment, patterns of care, and quality of care in a large state Medicaid program.Methods: Data from Pennsylvania Medicaid from 2007 to 2012 provided information regarding diagnoses, demographic characteristics, enrollment, and use of inpatient and outpatient services, and prescription drugs. We identified adult enrollees using buprenorphine, and examined prevalence of OUD diagnosis and patterns of use (duration and dose) and quality of care (physician visits, receipt of behavioral health counseling, urine drug screens, and other prescription drug use). We use a mixed logistic regression model to examine enrollee characteristics associated with buprenorphine use.Results: The share of enrollees with OUD filling prescriptions for buprenorphine increased from 2985 (9.8%) to 12,691 (25.2%) from 2007 to 2012. Between 26.2 and 32.0% of enrollees using buprenorphine had no diagnosis of OUD, depending on the year. Only 60.1% of enrollees with buprenorphine use received at least one urine drug screen, 41.0% had behavioral health counseling services, and 34.7 and 38.0% had other opioid and benzodiazepine claims, respectively, concomitant with buprenorphine use. Quality of care was lower among those with no OUD diagnosis recorded. The mean daily doses of buprenorphine decreased over time. We found wide variation in likelihood of buprenorphine use among those with OUD based upon age, sex, and race.Conclusions: Increases in buprenorphine treatment in a Medicaid population were observed across time; however, increases varied by age, sex, and rate, and the quality of care received seemed to be generally poor. The quality of the provision of buprenorphine treatment occurring in Medicaid populations should be further explored.