Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine
Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine
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DOI：
10.1016/j.amepre.2018.02.006
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发表时间：
2018-06-01
影响因子：
5.5
通讯作者：
Patterson, Davis G.
中科院分区：
文献类型：
--
作者：
Andrilla, C. Holly A.;Coulthard, Cynthia;Patterson, Davis G.
阿片类药物使用障碍是一个严重的公共卫生负担，特别是在美国农村地区。虽然已努力增加丁丙诺啡的供应，（一种以办公室为基础的药物辅助治疗），在美国超过60%的农村县缺乏一个医生与缉毒局豁免开它。方法：这项研究调查了2016年美国所有获得美国缉毒局豁免的农村医生，他们在美国为阿片类药物使用障碍开丁丙诺啡，并询问了结果：虽然89.4%的医生报告曾为阿片类药物使用障碍开过丁丙诺啡处方，但目前只有56.2%的医生接受新患者的治疗。30名患者豁免的医生平均治疗8.8名患者，但53%没有治疗任何患者。那些有100名患者豁免的患者平均治疗56.9名患者。美国各地的人口普查部门发现了显著的实践差异;太平洋人口普查部门的更多医生接受自己的患者接受丁丙诺啡治疗，而新英格兰人口普查部门的更多医生接受其他临床医生的患者。虽然大多数医生接受私人保险，但东南中部和西南中部人口普查区接受医疗补助的医生明显较少。这些研究结果表明，如果没有纳入有关医生是否接受新患者，有多少患者正在接受治疗，以及接受哪些患者和报销的信息，使用缉毒局豁免医生名单估计丁丙诺啡治疗服务的供应将高估治疗的可用性。(C)2018年美国预防医学杂志。爱思唯尔公司出版
Introduction: Opioid use disorder is a serious public health burden, especially throughout rural America. Although efforts have been made to increase the availability of buprenorphine (an office-based medication-assisted treatment), more than 60% of rural counties in the U.S. lack a physician with a Drug Enforcement Administration waiver to prescribe it.Methods: This study surveyed all rural physicians with a Drug Enforcement Administration waiver in 2016 to prescribe buprenorphine for opioid use disorder in the U.S. and asked about physician's demographics, prescribing practices, and barriers to prescribing buprenorphine for treatment of opioid use disorder.Results: Although 89.4% of physicians reported having prescribed buprenorphine for opioid use disorder, only 56.2% were currently accepting new patients for treatment. Physicians with a 30-patient waiver were treating, on average, 8.8 patients, but 53% were not treating any patients. Those with a 100-patient waiver were treating, on average, 56.9 patients. Significant practice variations were found throughout the U.S. by Census Division; more physicians in the Pacific Census Division accepted their own patients for treatment with buprenorphine whereas more physicians in the New England Census Divisions accepted patients of other clinicians in their practice. Although most physicians accepted private insurance, significantly fewer physicians in the East South Central and West South Central Census Divisions accepted Medicaid.Conclusions: These findings suggest that without incorporating information about whether or not physicians are accepting new patients, how many patients are being treated, and which patients and reimbursements are accepted, estimating the supply of buprenorphine treatment services using the Drug Enforcement Administration waivered physicians list will overestimate treatment availability. (C) 2018 American Journal of Preventive Medicine. Published by Elsevier Inc.