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

项目概要/摘要 针对PAR-18 - 747，应对阿片类药物流行在少数民族健康和 在美国的健康差异研究（R01）中，我们提出了入学性别差异的纵向分析， 获得和参与阿片类药物使用障碍（OUD）的药物辅助治疗（MAT）。我们的研究 团队成员包括性别差异（Marsh博士和Grella博士）、MAT准入（格雷罗博士和 Hortensia Amaro）和先进的纵向入路（Kong和Hedeker博士）。我们将从独特的 Medicaid扩展之前（2011 - 2013年）和之后（2015 - 2017年）的多年计划和客户级数据 发现差距，并审查妇女风险的作用、方案能力和综合服务， 随着时间的推移消除差异。在目标1中，我们将检测治疗进入（客户）趋势的性别差异 与OUD）、访问（等待时间）和参与（保留和辍学风险），从2011年到2012年，洛杉矶县的 2017.这将提供第一个已知的证据，表明在治疗进入、获得和治疗的过程中存在基于性别的趋势。 参与MAT在美国最大的公共资助的处理系统之一。在目标2中，我们 寻求通过风险特征了解男性和女性之间以及患有OUD的女性之间的差异， 计划因素贯穿治疗获取和参与的关键结果。这将提供第一个已知的 有证据表明，妇女和男子获得和参与MAT方案的途径不同。在目标3中， 将检查医疗补助扩大对OUD妇女的影响，控制客户风险状况， 计划能力，在治疗进入，访问和参与的结果。这项工作将记录 医疗补助扩展对妇女MAT进入、获得和参与的影响。我们的发现将告知健康 护理政策和做法，并推进系统科学和实践准则，以加强获得和 参与照顾患有OUD的妇女，这是受目前影响的最脆弱人群之一， 阿片类药物流行病

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.