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

摘要 药物辅助治疗（MAT）是阿片类药物使用障碍（OUD）的循证治疗， 药物治疗和行为治疗尽管为增加获得MAT的机会投入了大量的公共开支，但MAT的使用率仍然很低。 仍然很低。MAT的有限地理访问是OUD治疗的关键障碍，因为MAT需要 经常出差到供应商。虽然扩大MAT的地理访问一直是政策的优先事项， 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。的 本提案的总体目标是确定在哪些地方以及对哪些人的MAT地理访问受到限制， 并研究MAT的地理可及性如何影响OUD相关的健康结果。的假设是 弱势社会经济群体获得MAT的地理机会较低， 地理上获得MAT改善了与OUD相关的健康结果。该项目的基本原理是， 改善对获取MAT的地理可及性的衡量，将使决策者能够实施有针对性的、有效的 * 采取干预措施，增加获得和使用MAT的机会。申请人将使用宾夕法尼亚州医疗补助索赔， 提出以下具体目标：（1）描述驾车前往MAT供应商的地理位置差异 （2）确定与地理通道相关的患者和环境特征， MAT;（3）确定MAT的地理访问对MAT使用和OUD相关过量的影响。 这一应用是创新的，因为它将采用新的方法来衡量地理访问MAT， 包括在公共交通方面的不平等（这对低收入人口特别重要， 医疗补助），并使用这些措施与因果推理方法，以估计因果影响的地理 获得关于OUD相关结局的MAT（包括接受MAT和阿片类药物过量）。拟议 研究是重要的，因为它将使决策者和研究人员能够准确地识别小 需要采取有针对性的干预措施以改善获得MAT的地理区域。它还将 估计这些干预措施的有效性。最终，这项研究将证明 决策者可以据此确定干预措施的优先次序并分配资源， 地理上的MAT。通过在多学科支助下制定的培训计划， 导师团队NIH资助的调查人员，该项目将使申请人制定一个工作 处理OUD的知识和MAT政策和地理空间方法的专业知识。该项目还 强调向州医疗补助管理人员传播结果。总体而言，该项目将 通过向NIDA提交R 01申请，为申请人过渡到独立做好准备， 不同的州政策通过影响MAT的地理访问来影响OUD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.