Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018
Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018
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DOI：
10.1001/jama.2021.7374
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发表时间：
2021-07-13
影响因子：
120.7
通讯作者：
Kennedy, Susan
中科院分区：
文献类型：
--
作者：
Donohue, Julie M.;Jarlenski, Marian P.;Kennedy, Susan
重要性：关于阿片类药物使用障碍（OUD）在医疗补助计划参保者中的治疗趋势的信息有限。目的探讨多个州OUD药物的使用情况及潜在的护理质量指标。设计、设置和参与者：探索性连续横断面研究纳入了2014年至2018年11个州的1024301名年龄在12至64岁之间（不符合医疗保险资格）的医疗补助参保者，这些参保者使用《国际疾病分类第九次修订》（ICD-9或ICD-10）编码进行OUD。每个州使用广义估计方程来估计入组者特征和结果测量患病率之间的关联，随后使用随机效应荟萃分析汇总以产生全球估计。暴露年份、人口统计学特征、合格人群和合并症。治疗OUD的药物（丁丙诺啡、美沙酮或纳曲酮）的使用；潜在的质量指标（持续用药180天、行为健康咨询、尿检）；质量差的潜在指标（阿片类镇痛药和苯二氮卓类药物的处方）。结果2018年，41.7%的医疗补助OUD患者年龄在21至34岁之间，51.2%为女性，76.1%为非西班牙裔白人，50.7%通过医疗补助扩张符合条件，50.6%患有其他物质使用障碍。这11个州的OUD患病率从2014年的3.3%（8 737 082人中290 628人）增加到2018年的5.0%（10 585 790人中527 983人）。接受药物治疗的OUD患者的总患病率从2014年的47.8%（各州范围，35.3%至74.5%）增加到2018年的57.1%（范围，45.7%至71.7%）。2014-2015年至2017-2018年期间，连续接受180天OUD药物治疗的入组者的总体患病率没有显著变化（患病率差异为-0.01,95% CI为-0.03至0.02），趋势状态变化（90%预测区间为-0.08至0.06）。非西班牙裔黑人受试者的OUD药物使用低于白人受试者(患病率比[PR]， 0.72; 95% CI, 0.64 ~ 0.81
IMPORTANCE There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.OBJECTIVE To examine the use of medications for OUD and potential indicators of quality of care in multiple states.DESIGN, SETTING, AND PARTICIPANTS Exploratory serial cross-sectional study of 1 024 301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses.EXPOSURES Calendar year, demographic characteristics, eligibility groups, and comorbidities.MAIN OUTCOMES AND MEASURES Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines).RESULTS In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3%(290 628 of 8 737 082) in 2014 to 5.0%(527 983 of 10 585 790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (-0.01 prevalence difference, 95% CI, -0.03 to 0.02) with state variability in trend (90% prediction interval, -0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P