Buprenorphine prescribing for opioid use disorder in medical practices: can office-based out-patient care address the opiate crisis in the United States?
Buprenorphine prescribing for opioid use disorder in medical practices: can office-based out-patient care address the opiate crisis in the United States?
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DOI：
10.1111/add.14733
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发表时间：
2019-07-25
期刊：
影响因子：
6
通讯作者：
Rosenheck, Robert A.
中科院分区：
文献类型：
--
作者：
Rhee, Taeho Greg;Rosenheck, Robert A.
背景和目的阿片类药物使用障碍（OUD）仍然是一个严重的公共卫生问题，治疗成人OUD是美国的一个主要优先事项。关于OUD的诊断趋势和医生在办公室医疗实践中开丁丙诺啡处方的趋势知之甚少。我们试图描述2006年至2015年期间美国成人OUD诊断和丁丙诺啡处方的特征。设计和设置我们使用了重复的横断面设计，基于2006-15年全国门诊医疗调查的数据，调查了全国代表性的门诊医生就诊样本。参与者包括18岁或以上诊断为OUD的成年患者（n = 1034未加权）。丁丙诺啡处方定义为访视是否涉及丁丙诺啡或丁丙诺啡-纳洛酮。我们还检查了其他协变量（例如年龄、性别、种族和精神病合并症）。结果我们观察到，在办公室为基础的医疗实践中，OUD的诊断几乎增加了两倍，从2006-10年的0. 14%增加到2011-15年的0. 38%（P <0. 001）。在诊断为OUD的成年人中，丁丙诺啡处方从2006-10年的56.1%增加到2011-15年的73.6%（P = 0.126）。如果是西班牙裔[调整后的比值比（aOR）= 0.26; 95%置信区间（CI）= 0.11，0.60]，有医疗补助保险，（aOR = 0.27; 95% CI = 0.10，0.74）或诊断为其他精神疾病（aOR = 0.45; 95% CI = 0.25，0.83）或物质使用障碍（aOR = 0.19; 95% CI = 0.09，0.41）。结论：在美国以办公室为基础的医疗实践中，阿片类药物使用障碍的诊断和阿片类药物使用障碍成人的丁丙诺啡处方分别从2006-10年的0.14%和56.1%增加到2011-15年的0.38%和73.6%。
Background and aims Opioid use disorder (OUD) remains a serious public health issue, and treating adults with OUD is a major priority in the United States. Little is known about trends in the diagnosis of OUD and in buprenorphine prescribing by physicians in office-based medical practices. We sought to characterize OUD diagnoses and buprenorphine prescribing among adults with OUD in the United States between 2006 and 2015. Design and settings We used a repeated cross-sectional design, based on data from the 2006-15 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based out-patient physician visits. Participants Adult patients aged 18 years or older with a diagnosis of OUD (n = 1034 unweighted) were included. Measurements Buprenorphine prescribing was defined by whether visits involved buprenorphine or buprenorphine-naloxone, or not. We also examined other covariates (e.g. age, gender, race and psychiatric comorbidities). Findings We observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-10 to 0.38% in 2011-15 in office-based medical practices (P < 0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-10 to 73.6% in 2011-15 (P = 0.126). Adults with OUD were less likely to receive buprenorphine prescriptions if they were Hispanic [adjusted odds ratio (aOR) = 0.26; 95% confidence interval (CI) = 0.11, 0.60], had Medicaid insurance (aOR = 0.27; 95% CI = 0.10, 0.74) or were diagnosed with other psychiatric disorders (aOR = 0.45; 95% CI = 0.25, 0.83) or substance use disorders (aOR = 0.19; 95% CI = 0.09, 0.41). Conclusions In office-based medical practices in the United States, diagnoses for opioid use disorder and buprenorphine prescriptions for adults with opioid use disorder increased from 0.14 and 56.1%, respectively, in 2006-10 to 0.38 and 73.6% in 2011-15.