Medication treatment for opioid use disorder among rural primary care patients.
Medication treatment for opioid use disorder among rural primary care patients.
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农村初级保健患者阿片类药物使用障碍的药物治疗。
DOI：
10.1111/jrh.12785
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Saxon,AndrewJ
中科院分区：
文献类型：
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作者：
Hser,Yih-Ing;Zhu,Yuhui;Baldwin,Laura-Mae;Mooney,LarissaJ;Saxon,AndrewJ
目的调查农村初级保健机构阿片类药物使用障碍（OUD）的患病率和接受OUD的药物治疗情况，并确定OUD患者中与OUD相关的特征。方法对2019年10月至2021年1月在6个农村初级保健诊所中的1个就诊的所有成年患者的电子健康记录进行二次分析。采用混合效应logistic回归来评估mod收纳（Y/N）与患者特征（如人口统计学、其他物质使用障碍[SUDs]、精神健康障碍和慢性疼痛）和每家诊所开mod处方者数量的关系。结果：在6个诊所的36,762名初级保健患者中，OUD的患病率从0.7%到8.2%不等（Mean [SD] = 3.3% [95% CI: 0.4, 6.1]）。在1164例OUD患者中，平均50.1%接受了mod治疗（95% CI: 28.0, 72.3）。在处方者超过3名的诊所中，患者接受mod治疗的几率是少于3名诊所患者的3倍以上（OR = 3.42; 95% CI, 1.22‐9.62）。相对于65岁及以上的患者，mod与年龄较低（18‐30岁[OR = 6.97; 95% CI, 3.37‐14.42]、31‐64岁[OR = 5.03; 95% CI, 2.64‐9.57]）、患有其他并发sud （OR = 3.77; 95% CI, 2.57‐5.52）、男性（OR = 1.50; 95% CI, 1.12‐2.01）呈正相关，与患有慢性疼痛疾病负相关（OR = 0.69; 95% CI, 0.50‐0.94）。结论OUD和mod的患病率较高，但在农村初级保健诊所差异较大；初级保健用药处方者在农村地区获得用药方面发挥关键作用。
PurposeTo investigate the prevalence of opioid use disorder (OUD) and medication treatment for OUD (MOUD) receipt in rural primary care settings and identify characteristics associated with MOUD among patients with OUD.MethodsSecondary analyses based on electronic health records of all adult patients who visited 1 of the 6 rural primary care clinic sites from October 2019 to January 2021. Mixed effects logistic regression was conducted to assess MOUD receipt (Y/N) in relation to patient characteristics (eg, demographics, other substance use disorders [SUDs], mental health disorders, and chronic pain) and the number of MOUD prescribers per clinic.FindingsThe prevalence of OUD varied from 0.7% to 8.2% (Mean [SD] = 3.3% [95% CI: 0.4, 6.1]) among 36,762 primary care patients across 6 clinic sites. Among 1,164 patients with OUD, on average 50.1% received MOUD (95% CI: 28.0, 72.3). Patients in clinics with more than 3 MOUD prescribers had more than 3 times the odds of receiving MOUD (OR = 3.42; 95% CI, 1.22‐9.62) as those in clinics with fewer than 3 prescribers. MOUD was positively associated with younger age (18‐30 [OR = 6.97; 95% CI, 3.37‐14.42], 31‐64 [OR = 5.03; 95% CI, 2.64‐9.57], relative to those 65 and older), having other co‐occurring SUDs (OR = 3.77; 95% CI, 2.57‐5.52), being male (OR = 1.50; 95% CI, 1.12‐2.01), and negatively associated with having chronic pain disorders (OR = 0.69; 95% CI, 0.50‐0.94).ConclusionsThe prevalence of OUD and MOUD are high but vary considerably across rural primary care clinics; primary care MOUD prescribers play a key role on MOUD access in rural settings.