WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.
WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.
Am J Prev Med. 2018 Jun;54(6 Suppl 3):S208-S214. doi: 10.1016/j.amepre.2018.02.006.
Opioid use disorder is a serious public health burden, especially throughout rural America. Although efforts have been made to increase the availability of buprenorphine (an office-based medication-assisted treatment), more than 60% of rural counties in the U.S. lack a physician with a Drug Enforcement Administration waiver to prescribe it.
This study surveyed all rural physicians with a Drug Enforcement Administration waiver in 2016 to prescribe buprenorphine for opioid use disorder in the U.S. and asked about physician's demographics, prescribing practices, and barriers to prescribing buprenorphine for treatment of opioid use disorder.
Although 89.4% of physicians reported having prescribed buprenorphine for opioid use disorder, only 56.2% were currently accepting new patients for treatment. Physicians with a 30-patient waiver were treating, on average, 8.8 patients, but 53% were not treating any patients. Those with a 100-patient waiver were treating, on average, 56.9 patients. Significant practice variations were found throughout the U.S. by Census Division; more physicians in the Pacific Census Division accepted their own patients for treatment with buprenorphine whereas more physicians in the New England Census Divisions accepted patients of other clinicians in their practice. Although most physicians accepted private insurance, significantly fewer physicians in the East South Central and West South Central Census Divisions accepted Medicaid.
These findings suggest that without incorporating information about whether or not physicians are accepting new patients, how many patients are being treated, and which patients and reimbursements are accepted, estimating the supply of buprenorphine treatment services using the Drug Enforcement Administration waivered physicians list will overestimate treatment availability.
This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
阿片类药物使用障碍是一个严重的公共卫生负担，尤其是在美国农村地区。尽管已经努力增加丁丙诺啡（一种基于办公室的药物辅助治疗）的可及性，但美国仍有超过 60%的农村县缺乏拥有药物管制局豁免权可开具该药的医生。
本研究调查了美国所有拥有药物管制局豁免权可开具丁丙诺啡治疗阿片类药物使用障碍的农村医生，询问了医生的人口统计学、处方实践情况以及开具丁丙诺啡治疗阿片类药物使用障碍的障碍。
尽管 89.4%的医生报告曾开具丁丙诺啡治疗阿片类药物使用障碍，但只有 56.2%的医生目前正在接受新患者治疗。拥有 30 名患者豁免权的医生平均治疗 8.8 名患者，但 53%的医生没有治疗任何患者。拥有 100 名患者豁免权的医生平均治疗 56.9 名患者。通过人口普查部门，全美各地的实践差异显著；太平洋人口普查区的医生更愿意接受自己的患者接受丁丙诺啡治疗，而新英格兰人口普查区的医生更愿意接受他们实践中的其他临床医生的患者。尽管大多数医生接受私人保险，但接受医疗补助的医生明显较少，东中南部和中西南部人口普查区的医生更是如此。
这些发现表明，如果不了解医生是否接受新患者、治疗了多少患者以及接受了哪些患者和报销，仅使用药物管制局豁免医生名单来估计丁丙诺啡治疗服务的供应，将高估治疗的可及性。
本文是题为《行为健康劳动力：规划、实践和准备》的补充文章的一部分，该补充文章由美国卫生与公众服务部下属的药物滥用和精神卫生服务管理局以及卫生资源和服务管理局赞助。
