Oral Health Utilization and Outcomes Among Patients on Medications for Opioid Use Disorder

项目摘要/摘要(30行) 我们试图了解丁丙诺啡和丁丙诺啡的启动之间是否存在联系。 在退伍军人管理局接受诊断的一组患者中进行的一项回顾性研究中的不良牙科结果 阿片类药物使用障碍。先前的数据表明，丁丙诺啡开始使用后出现了牙科问题， 然而，简单的丁丙诺啡启动后评估将不足以回答以下问题 由于混淆而产生的联想。牙病会随着年龄和时间的推移而恶化，这是一个时间的例子- 不同的混淆，OUD患者一旦接受治疗，可能更有可能寻求常规医疗保健 这是由于活跃的成瘾而推迟的，这是健康的使用者或追随者偏见的一个例子。因此，我们寻求 使用目标1描述Moud处方的纵向模式，以及预防性和预防性模式 随着时间的推移，急性牙科护理服务。 为了严格了解跨粘膜丁丙诺啡与不良牙科治疗结果的关系，我们将 需要一个适当的对照组，并将混淆降至最低。为了实现这一点，在目标2中，我们将比较 OUD患者对经粘膜丁丙诺啡(我们的主要暴露组)接受OUD的患者 使用阴性对照结果的注射或植入丁丙诺啡、美沙酮和纳曲酮。 一旦我们根据目标2中的分析确定了适当的控制组，在目标3中我们将 报告经粘膜给药患者牙科不良的累积风险和风险差异 丁丙诺啡与其他Moud的比较。 我们将使用退伍军人事务部数据仓库来获得患者的处方和牙科数据 2001年至2021年期间进行的诊断。我们的研究团队非常适合采用我们建议的 方法论。Durkin博士和Roy博士(Co-PI)有使用大型处方数据集来理解 使用率的趋势。巴特勒博士(Co-I)在使用负面控制结果以减少 比较有效性研究中的偏差。苏达博士(Co-I)在退伍军人事务部企业数据仓库方面拥有专业知识 以及使用大型数据集来了解牙科医疗保健的利用模式。 如果没有严格的研究，FDA的警告可能会产生意想不到的后果，阻止患者 丁丙诺啡的起效。鉴于阿片类药物过量流行和穆德的已知好处，尽一切努力 必须减少丁丙诺啡的启动障碍。这项研究将是了解 经粘膜丁丙诺啡与牙科疗效之间的关系。

Project Summary/Abstract (30 lines) We seek to understand what if any relationship exists between initiation of transmucosal buprenorphine and poor dental outcomes in a retrospective study among a cohort of patients followed at the VA with a diagnosis of opioid use disorder. Prior data suggest that dental problems have arisen after initiation of buprenorphine, however a simple pre-post evaluation of buprenorphine initiation would be insufficient to answer the question of an association, due to confounding. Dental disease worsens with age and over time, an example of time- varying confounding, and patients with OUD, once in treatment, may be more likely to seek routine healthcare that was deferred due to active addiction, an example of healthy user or adherer bias. As a result, we seek to use Aim 1 to characterize longitudinal patterns of MOUD prescribing, as well as patterns of preventive and acute dental care services over time. To rigorously understand the association of transmucosal buprenorphine and poor dental outcomes, we will require an adequate control group with minimal confounding. To achieve this, in Aim 2 we will compare patients with OUD on transmucosal buprenorphine (our main exposure group) to patients with OUD receiving injectable or implantable buprenorphine, methadone, and naltrexone using negative control outcomes. Once we have determined appropriate control groups based on our analyses from Aim 2, in Aim 3 we will report the cumulative risk and risk difference of poor dental outcomes among patients on transmucosal buprenorphine as compared to other MOUD. We will use the VA Corporate Data Warehouse to obtain both prescribing and dental data among patients with OUD diagnosis between 2001 and 2021. Our study team is uniquely suited to employ our proposed methodologies. Drs. Durkin and Roy (Co-PIs) have experience using large prescription datasets to understand trends in utilization. Dr. Butler (Co-I) has extensive expertise in the use of negative control outcomes to reduce bias in comparative effectiveness studies. Dr. Suda (Co-I) has expertise in the VA Corporate Data Warehouse and the use of large datasets to understand dental healthcare utilization patterns. Without rigorous study, the FDA warning may have the unintended consequence of deterring patients from initiation of buprenorphine. In light of the opioid overdose epidemic and known benefits of MOUD, every effort must be made to reduce barriers to initiating buprenorphine. This study will be the first step in understanding the association between transmucosal buprenorphine and dental outcomes.