Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study.
Predictors of enrollment in opioid agonist therapy after opioid overdose or diagnosis with opioid use disorder: A cohort study.
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阿片类药物过量或诊断为阿片类药物使用障碍后参加阿片类激动剂治疗的预测因素：一项队列研究。
DOI：
10.1016/j.drugalcdep.2020.108435
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发表时间：
2021-02-01
影响因子：
4.2
通讯作者：
Marshall BDL
中科院分区：
文献类型：
--
作者：
Macmadu A;Paull K;Youssef R;Batthala S;Wilson KH;Samuels EA;Yedinak JL;Marshall BDL
医疗补助受助人有阿片类药物过量和阿片类药物使用障碍（OUD）的高负担。阿片类激动剂治疗是治疗OUD的有效方法，但在适用者和接受治疗者之间存在广泛且持续的差距。本研究的目的是确定在医疗补助接受者队列中阿片类药物过量或OUD诊断后6个月内接受阿片类激动剂治疗的预测因素。使用多个链接的州级数据库，我们对2013年7月至2018年6月期间在罗得岛有阿片类药物过量或OUD诊断的17，449名医疗补助接受者进行了回顾性队列研究。大多数（58%）医疗补助接受者在6个月内没有参加阿片类激动剂治疗。在校正模型中，有一次或多次既往用药过量（校正风险比[ARR]=0.33，95% CI：0.28，0.38）、酒精使用障碍（ARR=0.56，95% CI：0.52，0.60）或背部问题（ARR=0.58，95% CI：0.55，0.61）是未入组的强预测因素。相反，急诊科（ARR=1.31，95% CI：1.28-1.34）和初级保健提供者（ARR=1.03，95% CI：1.01-1.34）访视频率高于第75百分位数与阿片类激动剂治疗的及时入组相关。我们的研究结果强调，需要通过与医疗保健系统的各种参与节点来加强治疗OUD的途径。改善OUD筛查和阿片类激动剂治疗转诊的干预措施应包括高影响力的环境，例如酒精和药物使用障碍的治疗项目、疼痛诊所和门诊行为护理环境。
Medicaid recipients have a high burden of opioid overdose and opioid use disorder (OUD). Opioid agonist therapies are an effective treatment for OUD, but there is a wide and persisting gap between those who are indicated and those who receive treatment. The objective of this study was to identify the predictors of enrollment in opioid agonist therapy within 6 months of an opioid overdose or OUD diagnosis in a cohort of Medicaid recipients. Using multiple linked, state-level databases, we conducted a retrospective cohort study of 17,449 Medicaid recipients in Rhode Island who had an opioid overdose or an OUD diagnosis between July 2013 and June 2018. The majority (58%) of Medicaid recipients did not enroll in opioid agonist therapy within 6 months. In adjusted models, having one or more prior overdose (adjusted risk ratio [ARR]=0.33, 95% CI: 0.28, 0.38), alcohol use disorder (ARR=0.56, 95% CI: 0.52, 0.60), or back problems (ARR=0.58, 95% CI: 0.55, 0.61) were strong predictors of non-enrollment. Conversely, emergency department (ARR=1.31, 95% CI: 1.28–1.34) and primary care provider (ARR=1.03, 95% CI: 1.01–1.34) visit frequency above the 75th percentile were associated with timely enrollment in opioid agonist therapy. Our findings underscore the need to enhance pathways to treatment for OUD through varied nodes of engagement with healthcare systems. Interventions to improve screening for OUD and referrals to opioid agonist therapies should include high-impact settings, such as treatment programs for alcohol and substance use disorders, pain clinics, and outpatient behavioral care settings.
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