Specialty Provider Prescribing of Medications to Treat Opioid Use Disorder in Older Adults

专业医疗服务提供者开出治疗老年人阿片类药物使用障碍的药物

• 批准号: 10370787
• 负责人: Jonathan Cantor
• 金额: $ 23.66万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10370787
• 关键词: Academy; Accident and Emergency department; Adult; Affect; American; Area; Buprenorphine; Caring; Characteristics; County; Data; Data Linkages; Data Set; Databases; Diagnosis; Disadvantaged; Drug Prescriptions; Elderly; Emergency department visit; Ethnic Origin; Event; Exposure to; Future; Geographic Locations; Geography; Government Officials; Growth; Health; Health Personnel; Hospitalization; Improve Access; Inpatients; Knowledge; Life Expectancy; Link; Measures; Medicaid; Medicare; Medicare claim; Medicine; Methadone; Naltrexone; Opioid; Outcome; Outpatients; Overdose; Overdose reduction; Pain; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Physical Dependence; Policies; Population; Prevention; Privatization; Provider; Public Health; Quality of Care; Race; Records; Reporting; Research; Substance Use Disorder; Surveys; Time; Treatment Cost; United States; United States Centers for Medicare and Medicaid Services; Variant; aged; base; beneficiary; bundled payment; chronic pain management; experience; geographic disparity; health care service utilization; health disparity; high risk; human old age (65+); improved; innovation; inpatient service; medical specialties; mortality; novel; opioid epidemic; opioid misuse; opioid mortality; opioid treatment program; opioid use disorder; overdose death; payment; population based; prescription opioid; response; rural area; rural counties; sociodemographic disparity; sociodemographics; substance abuse treatment; substance use treatment; treatment center; treatment disparity; treatment services; young adult

Project Summary Drug overdose deaths that have included opioids have increased so rapidly over the past six years that the average life expectancy in the United States has declined. The national drug overdose rate for adults aged 65 and over increased by 7% from 2015 to 2016. Older adults may be at higher risk for opioid-related deaths and hospitalizations because they are more likely to start treatment for chronic pain and are also at higher risk for physical dependence. In 2017 the most commonly reported reason for opioid misuse in adults 50 and older was “relative physical pain”. In 2018, 80% of Americans with opioid use disorders (OUD) received no treatment; older adults are particularly disadvantaged. This despite the fact that medications for the treatment of opioid use disorder (MOUD) are an effective form of treatment. In 2017, 35 percent of substance use disorder (SUD) treatment facilities accepted Medicare as payment. Additionally, lack of geographic access to SUD treatment facilities is a broad problem with 85 percent of counties in the U.S. lacking a treatment center with an opioid treatment program. For older adults, access challenges may be exacerbated as approximately 25 percent of Americans older than age 65 live in a small town or other rural area; a rate that is higher than for younger adults. Rural areas also tend to have fewer SUD treatment facilities and higher rates of overdose. The data typically used to track the supply of licensed SUD treatment facilities– the National Survey of Substance Abuse Treatment Services– do not contain measures on the use of MOUD by providers at the facility nor does it contain geographic identifiers below the state. The overall objective of this R21 is to increase understanding of MOUD use by providers at SUD treatment facilities; whether variation in MOUD use at SUD facilities is associated with disparities in treatment for older adults; and how policies to improve access affect health care utilization among older adults. Our specific aims are to: Aim 1: Identify sociodemographic and geographic disparities in MOUD use for Medicare beneficiaries receiving OUD treatment in SUD treatment facilities. Aim 2: Identify disparities in health care utilization outcomes, including ED and inpatient care for overdoses, associated with SUD treatment facilities’ MOUD use rates. Aim 3: Evaluate the effect of state policies associated with OUD treatment on MOUD use rates for beneficiaries receiving treatment in SUD treatment facilities. The proposed R21 is a necessary first step to creating data linkages between a novel dataset of SUD treatment facilities, their providers, and claims data. We use the combined dataset to understand the use of MOUD by these facilities in the treatment of OUD for Medicare beneficiaries. Based on our results, in a future R01 we hope to develop the first ever OUD quality of care measures for older adults at treatment facilities.

项目摘要 包括阿片类药物在内的药物过量死亡在过去六年中迅速增加， 美国的平均预期寿命已经下降。全国65岁以上成年人的药物过量率 2015年至2016年增长7%。老年人可能面临更高的阿片类药物相关死亡风险， 住院，因为他们更有可能开始治疗慢性疼痛，也有更高的风险， 身体依赖。2017年，50岁及以上成人滥用阿片类药物的最常见原因 是"相对的身体疼痛" 2018年，80%的阿片类药物使用障碍（OUD）美国人没有接受任何治疗。 治疗;老年人尤其处于不利地位。尽管治疗的药物 阿片类药物使用障碍（MOUD）是一种有效的治疗形式。 2017年，35%的物质使用障碍（SUD）治疗机构接受医疗保险作为付款。 此外，缺乏获得SUD治疗设施的地理通道是一个广泛的问题，85%的 在美国的县缺乏一个治疗中心与阿片类药物治疗计划。对于老年人， 挑战可能会加剧，因为大约25%的65岁以上的美国人生活在一个小的 城镇或其他农村地区;比年轻人高的比率。农村地区的SUD也往往较少 治疗设施和更高的吸毒过量率。通常用于跟踪许可SUD供应的数据 药物滥用治疗机构----全国药物滥用治疗服务调查----不包含关于以下方面的措施： 提供商在设施中使用MOUD，也不包含州以下的地理标识符。的 本R21的总体目标是增加供应商在SUD治疗中对MOUD使用的理解 设施; SUD设施中MOUD使用的差异是否与老年人待遇的差异有关 以及改善获得保健服务的政策如何影响老年人对保健服务的利用。我们的具体目标 是： 目标1：确定医疗保险受益人使用MOUD的社会人口和地理差异 在SUD治疗设施接受OUD治疗。 目标2：确定卫生保健利用结果的差异，包括艾德和过量用药的住院治疗， 与SUD治疗设施的MOUD使用率相关。 目标3：评估与OUD治疗相关的国家政策对MOUD使用率的影响， 在单一用途医疗设施接受治疗的受益人。 建议的R21是在新的SUD数据集之间创建数据链接的必要的第一步 治疗设施、其提供者和索赔数据。我们使用组合数据集来了解 这些设施在治疗Medicare受益人的OUD时的MOUD。根据我们的研究结果， R01我们希望为治疗机构的老年人制定有史以来第一个OUD护理质量措施。