Influence of social vulnerability on buprenorphine treatment and opioid overdoses after an opioid-related emergency department visit among commercially insured and Medicare Advantage beneficiaries

商业保险和 Medicare Advantage 受益人在阿片类药物相关急诊就诊后，社会脆弱性对丁丙诺啡治疗和阿片类药物过量的影响

• 批准号: 10615419
• 负责人: Maria Anne Stevens
• 金额: $ 4.28万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10615419
• 关键词: Influence; social; vulnerability; buprenorphine; treatment

PROJECT SUMMARY/ABSTRACT Opioid overdoses continue to increase and disproportionately influence people experiencing greater social risk factors. Buprenorphine is a first-line treatment for opioid use disorder (OUD) that decreases opioid overdoses, especially when initiated in the emergency department (ED)— a high volume point-of-care. However, buprenorphine treatment inequities exist in and outside of the ED, and methodological challenges make it difficult to identify vulnerable populations with OUD who may benefit from improved access to, and quality of, buprenorphine treatment. The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention (CDC), is a measure that identifies vulnerable populations by capturing social risk factors in a region that influence health. A composite score is derived based on an area’s: 1) socioeconomic status; 2) household composition and disability; 3) minority status and language; 4) housing and transportation. Studies that examined the influence of area-level social risk factors on buprenorphine treatment and opioid overdoses were state specific or limited to county-level measures. No studies have examined the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit in people with OUD who have commercial or Medicare Advantage (aged and disabled) health insurance. This study will deploy the SVI at the residential zip-code level to investigate the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit using claims data (OptumLabs® Data Warehouse) from people with commercial or Medicare Advantage health insurance. Aim 1 will employ Cox hazard regression analysis to assess whether social vulnerability is associated with time to initiating buprenorphine treatment. Aim 2 will estimate the effect of social vulnerability on buprenorphine treatment retention for at least 180 days, as well as eight other buprenorphine treatment quality measures from the American Society of Addiction Medicine (ASAM), using generalized estimating equations (GEE). Aim 3 will estimate the effect of prescribing practices on opioid overdoses using GEE. The results from this study will serve as a model for future research and inform targeted policy and clinical levers that improve access to, and quality of, buprenorphine treatment, as well as opioid- related outcomes, among people with OUD experiencing greater social risk factors.

项目概要/摘要 阿片类药物过量持续增加，并对经历过这种情况的人产生不成比例的影响 更大的社会风险因素。丁丙诺啡是阿片类药物使用障碍 (OUD) 的一线治疗药物 减少阿片类药物过量服用，尤其是在急诊室 (ED) 启动时—— 高容量的护理点。然而，国内外丁丙诺啡治疗存在不平等现象 教育部的工作人员和方法上的挑战使得很难确定弱势群体 OUD 可能受益于丁丙诺啡治疗的获取和质量的改善。 社会脆弱性指数（SVI），由美国疾病控制和预防中心制定 预防（CDC）是一种通过捕捉社会风险来识别弱势群体的措施 一个地区影响健康的因素。综合分数是根据区域的以下各项得出的：1) 社会经济地位； 2) 家庭构成和残疾情况； 3）少数民族地位和语言； 4）住房和交通。研究地区级社会风险的影响 丁丙诺啡治疗和阿片类药物过量的因素因州而异或仅限于 县级措施。尚无研究探讨社会脆弱性对 接受阿片类药物相关急诊就诊后的丁丙诺啡治疗和阿片类药物过量 拥有商业或 Medicare Advantage（老年和残疾人）健康保险的 OUD。 本研究将在住宅邮政编码级别部署 SVI，以调查以下因素的影响： 阿片类药物相关事件后丁丙诺啡治疗和阿片类药物过量的社会脆弱性 使用来自商业或商业人士的索赔数据（OptumLabs® 数据仓库）进行急诊就诊 Medicare Advantage 健康保险。目标 1 将采用 Cox 风险回归分析来 评估社会脆弱性是否与开始丁丙诺啡治疗的时间相关。 目标 2 将估计社会脆弱性对丁丙诺啡治疗保留的影响 至少 180 天，以及其他八项丁丙诺啡治疗质量措施 美国成瘾医学协会 (ASAM)，使用广义估计方程 (GEE)。 目标 3 将使用 GEE 评估处方实践对阿片类药物过量的影响。这 这项研究的结果将作为未来研究的模型，并为有针对性的政策和信息提供信息 改善丁丙诺啡以及阿片类药物治疗的可及性和质量的临床手段 相关结果，在 OUD 患者中经历更大的社会风险因素。