Adoption of Buprenorphine in an HMO Setting

描述（由申请人提供）： 食品和药物管理局批准丁丙诺啡用于治疗阿片类药物依赖，合格的医生可以在实践中治疗阿片类药物依赖。然而，报告表明，采用这种药物的速度缓慢。对丁丙诺啡在实践环境中的使用进行研究可能有助于确定更广泛使用的障碍。本研究探讨了丁丙诺啡的使用在两个大型团体的健康计划（凯撒永久西北和北方加州）。将从FDA批准丁丙诺啡之前（2000 - 2002年）和之后（2003 - 2008年）的行政数据系统中提取向诊断为阿片类药物依赖的成员提供的服务数据。对利用模式进行了评估，并估算了费用。病人和医生的访谈补充了定量分析，增加了趋势的细节，并建议使用丁丙诺啡作为解毒和维持药物的影响。调查有三个具体目标： 目标1：描述在两个健康计划中向被诊断为阿片类药物依赖的成员提供的医疗保健和成瘾医学服务（例如，使用初级保健、住院治疗、紧急护理和成瘾药物，包括丁丙诺啡、可乐定、美沙酮和咨询服务）。 目标二：检查与向诊断为阿片类药物依赖的患者提供的服务相关的健康计划和患者成本，并评估丁丙诺啡对这些成本的影响（估计年度成本，比较使用和不使用丁丙诺啡的患者，并评估患者成本）。 目标3：通过与530名患者和96名从业人员和管理人员的访谈，确定促进和抑制丁丙诺啡的采用和使用的因素。

DESCRIPTION (provided by applicant): The Food and Drug Administration approved buprenorphine for the treatment of opioid dependence and qualified physicians may treat opioid dependence in their practices. Reports suggest, however, that adoption of the medication has been slow. Studies of the use of buprenorphine in practice settings may help identify barriers to more widespread utilization. This study examines the use of buprenorphine within two large group health plans (Kaiser Permanente Northwest and Northern California). Data on services provided to members with diagnoses of opioid dependence will be extracted from administrative data systems for the period before (2000 - 2002) and after (2003 - 2008) FDA approval of buprenorphine. Utilization patterns are assessed and costs are estimated. Patient and practitioner interviews complement the quantitative analyses, add detail on trends, and suggest influences on the use of buprenorphine as a detoxification and maintenance medication. The investigation has three specific aims: Aim 1: Describe health care and addiction medicine services provided to members with a diagnosis of opioid dependence in two health plans (e.g., use of primary care, hospitalization, emergency care and addiction medicine including buprenorphine, clonidine, methadone, and counseling services). Aim 2: Examine the health plan and patient costs associated with services provided to patients with diagnoses of opioid dependence and assess the impact of buprenorphine on those costs (estimate annual costs, compare patients with and without buprenorphine, and assess patient costs). Aim 3: Identify factors that facilitate and inhibit the adoption and use of buprenorphine through interviews with 530 patients and 96 practitioners and administrators.