Primary Care Providers And Specialists Deliver Comparable Buprenorphine Treatment Quality.
Primary Care Providers And Specialists Deliver Comparable Buprenorphine Treatment Quality.
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DOI：
10.1377/hlthaff.2019.01559
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发表时间：
2020-08
期刊：
影响因子：
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通讯作者：
Domino ME
中科院分区：
文献类型：
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作者：
Gertner AK;Robertson AG;Powell BJ;Jones H;Silberman P;Domino ME
为了应对阿片类药物过量死亡人数的增加，呼吁初级保健提供者在为阿片类药物使用障碍提供丁丙诺啡治疗方面发挥更大的作用。然而，政策制定者和提供者担心，扩大治疗机会可能会降低治疗质量，初级保健提供者没有充分的能力提供丁丙诺啡治疗。针对这些问题，我们调查了两个研究问题：2014年至2017年北卡罗来纳州医疗补助计划中丁丙诺啡的使用和质量如何变化，以及在此期间北卡罗来纳州医疗补助计划中初级保健提供者和专家之间丁丙诺啡的治疗质量如何不同？我们测量丁丙诺啡治疗质量，作为患者在治疗中的保留和提供者对治疗指南的遵守。我们发现，接受阿片类药物使用障碍药物治疗的登记人数大幅增加，但接受治疗的登记人数比例仍然很低。在研究期间，丁丙诺啡治疗的质量有所提高，初级保健提供者提供的护理质量与其他提供者相当或更高。丁丙诺啡治疗的质量正在改善，但在使用和质量方面仍有改进的余地。我们的研究结果支持初级保健提供者在扩大阿片类药物使用障碍治疗方面的作用。
In response to rising numbers of opioid overdose deaths, primary care providers have been called on to play a greater role in delivering buprenorphine treatment for opioid use disorder. However, policy makers and providers have raised concerns that expanding treatment access may reduce treatment quality and that primary care providers are not well equipped to deliver buprenorphine treatment. We investigated two research questions in response to these concerns: How did buprenorphine treatment use and quality change in North Carolina Medicaid from 2014 to 2017, and how did buprenorphine treatment quality differ between primary care providers and specialists in North Carolina Medicaid during this period? We measured buprenorphine treatment quality as patients’ retention in treatment and providers’ adherence to treatment guidelines. We found that the number of enrollees receiving medication treatment for opioid use disorder increased substantially, but the percentage of enrollees with the disorder receiving treatment remained low. The quality of buprenorphine treatment increased during the study period, and primary care providers provided care of comparable or higher quality compared with that of other providers. Treatment quality for buprenorphine treatment is improving, but there remains room for improvement in both use and quality. Our results support the role of primary care providers in expanding treatment for opioid use disorder.
影响因子：
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作者：
Kansagra, Susan M;Cohen, Mandy K
通讯作者：
Cohen, Mandy K