Geographic Access to Medication Assisted Treatment for Medicaid Enrollees with Opioid Use Disorder

摘要 药物辅助治疗(Mat)是对阿片类药物使用障碍(Oud)的循证治疗，包括 药物和行为疗法。尽管在增加垫子使用方面投入了大量公共支出，但垫子的使用 仍然很低。接触MAT的地理位置有限是OUD治疗的关键障碍，因为MAT需要 经常出差到供应商那里。虽然扩大对MAT的地理访问一直是政策优先事项， 政策制定者缺乏可靠、准确的地理获取MAT的措施来指导规划工作。这个 这项提案的总体目标是确定在哪里以及对谁限制对MAT的地理访问， 并研究获得MAT的地理位置如何影响与OUD相关的健康结果。这些假设是 弱势社会经济群体获得MAT的地理位置较低，而且这一比例增加了 获得MAT的地理位置可改善与艾滋病相关的健康结果。这个项目的基本原理是 改进对MAT地理准入的衡量将使政策制定者能够有针对性地、有效地实施 增加垫子获取和使用的干预措施。申请者将使用宾夕法尼亚州医疗补助申请 解决以下具体目标：(1)描述通过汽车进入垫子供应商的地理差异 和公共交通；(2)确定与地理位置相关的患者和环境特征 以及(3)确定地理上接触垫子对垫子使用和与尿布相关的过量使用的影响。 这项应用是创新的，因为它将应用新的方法来测量通往垫子的地理通道， 包括乘坐公共交通工具的差距(这与#年的低收入人口特别相关 Medicaid)，并使用这些测量和因果推断方法来估计地理因素的因果影响 获得与OUD相关的结果的MAT(包括收到MAT和阿片类药物过量)。建议数 研究意义重大，因为它将使政策制定者和研究人员能够准确地识别 需要有针对性的干预措施以改善获得MAT的地理位置的地区。它还将 估计这种干预措施的效果。最终，这项拟议的研究将产生一个证据 政策制定者可以在此基础上确定干预措施的优先顺序并分配资源以有效地提高 可在地理位置上访问垫子。通过在多学科支持下制定的培训计划 由NIH资助的研究人员导师团队，这个项目将使申请者能够制定一项工作 具有治疗艾滋病的知识，并具备MAT政策和地理空间方法方面的专业知识。这个项目还 强调将结果传播给州医疗补助管理人员。总体而言，这个项目将 通过向NIDA提交R01申请来检查申请人如何过渡到独立，从而为申请人做好准备 不同的国家政策通过其对获得地区性信息技术的影响来影响与信息技术援助相关的结果。

Abstract Medication assisted treatment (MAT) is an evidence-based treatment for opioid use disorder (OUD) involving medication and behavioral therapy. Despite massive public expenditures to increase MAT access, MAT use remains low. Limited geographic access to MAT is a key barrier to OUD treatment because MAT requires frequent travel to providers. While expanding geographic access to MAT has been a policy priority, policymakers lack reliable, accurate measures of geographic access to MAT to guide planning efforts. The overall objectives of this proposal are to determine where and for whom geographic access to MAT is limited, and to examine how geographic access to MAT affects OUD-related health outcomes. The hypotheses are that geographic access to MAT is lower for disadvantaged socioeconomic groups, and that increased geographic access to MAT improves OUD-related health outcomes. The rationale for this project is that improved measurement of geographic access to MAT will enable policymakers to implement targeted, effective interventions to increase MAT access and use. The applicant will use Pennsylvania Medicaid claims to address the following specific aims: (1) Characterize variation in geographic access to MAT providers by car and public transit; (2) Identify patient and environmental characteristics associated with geographic access to MAT; and (3) Determine the impact of geographic access to MAT on MAT use and OUD-related overdoses. This application is innovative because it will apply novel methods for measuring geographic access to MAT, including disparities in access by public transit (which is particularly relevant to low-income populations in Medicaid), and use these measures with causal inference methods to estimate the causal effect of geographic access to MAT on OUD-related outcomes (including receipt of MAT and opioid overdoses). The proposed research is significant because it will enable policymakers and researchers to accurately identify small geographic areas where targeted interventions to improve geographic access to MAT are needed. It also will estimate how effective such interventions would be. Ultimately, the proposed research will create an evidence basis from which policymakers can prioritize interventions and allocate resources to efficiently increase geographic access to MAT. Through a training plan developed with the support of a multi-disciplinary mentorship team of NIH-funded investigators, this project will enable the applicant to develop a working knowledge of the treatment of OUD and expertise in MAT policy and geospatial methods. This project also places an emphasis on dissemination of results to state Medicaid administrators. Collectively, this project will prepare the applicant to transition to independence by submitting a R01 application to NIDA examining how various state policies affect OUD-related outcomes through their effects on geographic access to MAT.