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

项目概要/摘要（30行） 我们试图了解是否存在任何关系之间的启动经粘膜丁丙诺啡， 在一项回顾性研究中，一组患者在VA随访时诊断为 阿片类药物使用障碍先前的数据表明，在开始丁丙诺啡后出现了牙齿问题， 然而，对丁丙诺啡启动进行简单的前后评价不足以回答以下问题： 一种关联，由于混淆。牙病随着年龄和时间的推移而变化，一个时间的例子- 不同的混杂因素，OUD患者一旦接受治疗，可能更有可能寻求常规医疗保健 这是由于主动成瘾而推迟的，这是健康用户或坚持者偏见的一个例子。因此，我们力求 使用目标1来描述MOUD处方的纵向模式，以及预防和 长期的牙科护理服务。 为了严格了解透粘膜丁丙诺啡与不良牙科结局的关系，我们将 需要一个具有最小混杂的适当对照组。为了实现这一点，在目标2中，我们将比较 接受经粘膜丁丙诺啡治疗的OUD患者（我们的主要暴露组）与接受 注射或植入丁丙诺啡、美沙酮和纳洛酮，使用阴性对照结果。 一旦我们根据目标2的分析确定了适当的对照组，在目标3中，我们将 报告经粘膜给药患者中不良牙科结局的累积风险和风险差异 丁丙诺啡与其他MOUD相比。 我们将使用VA公司数据仓库来获得患者的处方和牙科数据， 2001年至2021年期间的OUD诊断。我们的研究团队是唯一适合雇用我们的建议 方法论。Drs. Durkin和Roy（Co-PI）具有使用大型处方数据集了解 利用的趋势。Butler博士（Co-I）在使用阴性对照结果以减少 比较有效性研究中的偏差。苏达博士（Co-I）拥有VA企业数据仓库方面的专业知识 以及使用大型数据集来了解牙科保健利用模式。 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 开始丁丙诺啡治疗鉴于阿片类药物过量流行和MOUD的已知益处， 以减少启动丁丙诺啡的障碍。这项研究将是了解 经粘膜丁丙诺啡与牙科结果之间的关联。

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.