1 Western New England University College of Pharmacy, Springfield, MA, USA.
2 Health New England Inc, Springfield, MA, USA.
Ann Pharmacother. 2018 May;52(5):405-414. doi: 10.1177/1060028017751913. Epub 2018 Jan 5.
Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use.
We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy.
The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence.
A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76).
Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.
阿片类药物使用障碍患者坚持药物辅助治疗与减少非法阿片类药物使用的可能性相关。
我们旨在描述保险患者新接受丁丙诺啡类药物治疗的治疗持续时间，并确定与 1 年持续治疗相关的因素。
回顾性观察队列包括雇主赞助和管理的医疗补助患者，他们于 2010 年 6 月 30 日至 2015 年 1 月 1 日期间开始接受丁丙诺啡类药物治疗。治疗持续时间既作为连续变量又作为二分变量（持续治疗 1 年的患者比例）进行测量。多变量逻辑回归分析用于确定与 1 年持续治疗相关的因素。
共有 302 名患者符合纳入标准。治疗期中位数（范围）为 1 期[1-4]。首次治疗期间平均治疗天数为 206（SD=152）天，有 40.4%（n=122）的患者持续治疗 1 年。同时开具处方类阿片类镇痛药（比值比[OR]=0.25；95%CI=0.12-0.51）、接受成瘾专家治疗（OR=0.40；95%CI=0.21-0.76）和医疗补助保险覆盖（OR=0.33；95%CI=0.13-0.84）与 1 年持续治疗显著负相关。与持续治疗呈负相关的还有住院治疗（OR=0.30；95%CI=0.12-0.76）。
一些医疗服务提供和使用变量与非持续治疗显著相关。同时使用处方类阿片类药物是医疗服务提供者和政策制定者可以采取行动以改善治疗持续的最易改变的危险因素。
