Blanchard Janice, Weiss Audrey J, Barrett Marguerite L, McDermott Kimberly W, Heslin Kevin C
RAND Corporation, 1200 Hayes Street, Arlington, VA, 22202, USA.
George Washington University, 2120 L Street NW, Suite 450, Washington, DC, 20037, USA.
BMC Health Serv Res. 2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8.
State policy approaches designed to provide opioid treatment options have received significant attention in addressing the opioid epidemic in the United States. In particular, expanded availability of naloxone to reverse overdose, Good Samaritan laws intended to protect individuals who attempt to provide or obtain emergency services for someone experiencing an opioid overdose, and expanded coverage of medication-assisted treatment (MAT) for individuals with opioid abuse or dependence may help curtail hospital readmissions from opioids. The objective of this retrospective cohort study was to evaluate the association between the presence of state opioid treatment policies-naloxone standing orders, Good Samaritan laws, and Medicaid medication-assisted treatment (MAT) coverage-and opioid-related hospital readmissions.
We used 2013-2015 hospital inpatient discharge data from 13 states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. We examined the relationship between state opioid treatment policies and 90-day opioid-related readmissions after a stay involving an opioid diagnosis.
Our sample included 383,334 opioid-related index hospitalizations. Patients treated in states with naloxone standing-order policies at the time of the index stay had higher adjusted odds of an opioid-related readmission than did those treated in states without such policies; however, this relationship was not present in states with Good Samaritan laws. Medicaid methadone coverage was associated with higher odds of readmission among all insurance groups except Medicaid. Medicaid MAT coverage generosity was associated with higher odds of readmission among the Medicaid group but lower odds of readmission among the Medicare and privately insured groups. More comprehensive Medicaid coverage of substance use disorder treatment and a greater number of opioid treatment programs were associated with lower odds of readmission.
Differences in index hospitalization rates suggest that states with opioid treatment policies had a higher level of need for opioid-related intervention, which also may account for higher rates of readmission. More research is needed to understand how these policies can be most effective in influencing acute care use.
旨在提供阿片类药物治疗方案的州政策措施在美国应对阿片类药物流行方面受到了广泛关注。特别是，扩大纳洛酮用于逆转过量用药的可及性、旨在保护为阿片类药物过量使用者提供或获取紧急服务的个人的《好撒玛利亚人法》，以及扩大对阿片类药物滥用或依赖者的药物辅助治疗（MAT）覆盖范围，可能有助于减少因阿片类药物导致的医院再入院情况。这项回顾性队列研究的目的是评估州阿片类药物治疗政策（纳洛酮常备医嘱、《好撒玛利亚人法》以及医疗补助药物辅助治疗（MAT）覆盖范围）的存在与阿片类药物相关医院再入院之间的关联。
我们使用了医疗保健研究与质量局医疗保健成本和利用项目中13个州2013 - 2015年的医院住院出院数据。我们研究了州阿片类药物治疗政策与涉及阿片类药物诊断住院后的90天阿片类药物相关再入院之间的关系。
我们的样本包括383,334例与阿片类药物相关的首次住院病例。在首次住院时所在州有纳洛酮常备医嘱政策的患者，与在没有此类政策的州接受治疗的患者相比，阿片类药物相关再入院的调整后几率更高；然而，在有《好撒玛利亚人法》的州这种关系并不存在。除医疗补助外，所有保险组中医疗补助美沙酮覆盖范围与再入院几率较高相关。医疗补助MAT覆盖范围的慷慨程度在医疗补助组中与再入院几率较高相关，但在医疗保险和私人保险组中与再入院几率较低相关。物质使用障碍治疗的更全面医疗补助覆盖范围以及更多的阿片类药物治疗项目与再入院几率较低相关。
首次住院率的差异表明，有阿片类药物治疗政策的州对阿片类药物相关干预的需求水平较高，这也可能是再入院率较高的原因。需要更多研究来了解这些政策如何能最有效地影响急性护理的使用。
