Gender Disparities in Access and Engagement in Medication-Assisted Treatment for Opioid Use Disorder

项目摘要/摘要 响应PAR-18-747，应对阿片类药物在少数民族健康和卫生领域流行的挑战 美国的健康差异研究(R01)，我们建议对进入的性别差异进行纵向分析， 获得和参与阿片类药物使用障碍的药物辅助治疗(MAT)。我们的研究 该团队包括性别差异(Marsh博士和Grella博士)、垫子准入(Guerrero博士和Gerrero博士)方面的主要专家 Hortensia Amaro)和先进的纵向方法(Kon博士和Hedeker博士)。我们将从独一无二的 医疗补助计划扩展前(2011-2013)和扩展后(2015-2017)的多年计划和客户级别数据 发现差距并检查风险对妇女、方案能力和综合服务的作用 加班加点消除差距。在目标1中，我们将检测治疗进入趋势(客户)的性别差异 从2011年起，洛杉矶县的OUD)、访问(等待时间)和参与度(留存和辍学风险)- 2017年。这将为基于性别的治疗进入、获得和治疗趋势提供第一个已知的证据 参与美国最大的公共资助治疗系统之一的MAT。在目标2中，我们将 寻求通过风险概况和风险分析了解男性和女性之间以及女性OID之间的差异 方案因素涵盖了治疗机会和参与度的关键结果。这将提供第一个已知的 女性和男性进入和参与MAT计划的不同途径的证据。在目标3中，我们 将检查医疗补助扩大对患有OID的女性的影响，控制客户风险概况和 方案能力，包括治疗进入、获取和参与的结果。这项工作将记录 扩大医疗补助对妇女进入、获得和参与的影响。我们的发现将告知健康 关怀政策和做法以及推进系统科学和做法指南，以增加获得和 参与照顾患有OUD的妇女，这是受当前艾滋病影响最脆弱的人群之一 阿片类药物泛滥。

PROJECT SUMMARY/ABSTRACT In response to PAR-18-747, Addressing the Challenges of the Opioid Epidemic in Minority Health and Health Disparities Research in the U.S. (R01), we propose longitudinal analyses of gender difference in entry, access, and engagement in medication-assisted treatment (MAT) for opioid use disorder (OUD). Our study team includes leading experts in gender disparities (Drs. Marsh and Grella), MAT access (Drs. Guerrero and Hortensia Amaro) and advanced longitudinal approaches (Drs. Kong and Hedeker). We will draw from unique multiyear, program- and client-level data from before (2011-2013) and after (2015-2017) Medicaid expansion to detect disparities and examine the role of risks to women, program capacity, and comprehensive services in eliminating disparities overtime. In Aim 1, we will detect gender differences in trends in treatment entry (clients with OUD), access (wait time), and engagement (retention and dropout risk) in Los Angeles County from 2011- 2017. This will provide the first-known evidence of gender-based trends in treatment entry, access, and engagement in MAT in one the largest publicly funded treatment systems in the United States. In Aim 2, we will seek to understand differences between men and women and among women with OUDs by risk profiles and program factors across key outcomes of treatment access and engagement. This will provide the first-known evidence of differential pathways for women and men to access and engage in MAT programs. In Aim 3, we will examine the effect of Medicaid expansion on women with OUDs, controlling for client risk profiles and program capacity, across outcomes of treatment entry, access, and engagement. This work will document the impact of Medicaid expansion on women's MAT entry, access and engagement. Our findings will inform health care policies and practices and advance systems science and practice guidelines to enhance access to and engagement in care for women with OUD, one of the most vulnerable populations affected by the current opioid epidemic.