Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population.
Patterns of clinic switching and continuity of medication for opioid use disorder in a Medicaid-enrolled population.
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DOI：
10.1016/j.drugalcdep.2021.108633
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发表时间：
2021-04-01
影响因子：
4.2
通讯作者：
Donohue JM
中科院分区：
文献类型：
--
作者：
Cole ES;Drake C;DiDomenico E;Sharbaugh M;Kim JY;Nagy D;Cochran G;Gordon AJ;Gellad WF;Pringle J;Warwick J;Chang CH;Kmiec J;Kelley D;Donohue JM
许多阿片使用障碍(OUD)患者在一家诊所开始治疗阿片使用障碍(Moud)，并在治疗过程中切换到另一家诊所。这些切换可能是由于推荐或计划外原因而发生的。然而，目前尚不清楚切换穆德诊所对穆德治疗的连续性或过量服药有什么影响。研究切换Moud诊所的模式及其与Moud覆盖的天数比例(PDC)和阿片类药物相关过量的关系。宾夕法尼亚州医疗补助申请数据的横断面回顾分析。Moud临床开关(即，从位于不同诊所的处方者那里填写Moud处方药)、PDC和阿片类药物相关过量。在14,107名参与者中，43.2%的人在270天的时间里至少更换了一次Moud诊所。在多因素回归分析中，非西班牙裔黑人(IRR=1.43；95%CI=1.24~1.65；P<；0.001)、有美沙酮使用史(IRR=1.32；95%CI=1.13~1.55；P<；0.001)和办公室总就诊次数(IRR=1.01；CI=1.01~1.01；P<；0.001)的参与者有更多的换工作机会。临床转诊次数与PDC呈正相关(OR=1.12；95%CI=1.10~1.13)。在二次分析中，我们发现，只切换一个Moud填充与较低的PDC相关(OR=0.97；95%CI=0.95-0.99)，而切换多个Moud填充与较高的PDC相关(OR=1.40；95%CI=1.36-1.44)。我们没有观察到阿片类药物相关过量与临床开关之间的关系。在与过量用药和PDC有关的范围内，缺乏接受Moud的处方连续性可能不会像其他情况那样成为问题。
Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses. To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose. Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data. MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose. Among 14,107 enrollees, 43.2% switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR=1.43; 95% CI=1.24–1.65; p<0.001), had previous methadone use (IRR=1.32; 95% CI=1.13–1.55; p<0.001), and a higher total number of office visits (IRR=1.01; CI=1.01–1.01; p<0.001) had more switches. The number of clinic switches was positively associated with PDC (OR=1.12; 95% CI=1.10–1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR=0.97; 95% CI=0.95–0.99), while switches for more than one MOUD fill were associated with higher PDC (OR=1.40; 95% CI=1.36–1.44). We did not observe a relationship between opioid-related overdose and clinic switches. Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
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