Bassett Medical Center, Bassett Research Institute, Cooperstown, NY, USA.
Department of Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Subst Abus. 2022;43(1):69-75. doi: 10.1080/08897077.2020.1736709. Epub 2020 Mar 9.
While primary care clinicians are being trained to use buprenorphine for the treatment of Opioid Use Disorder (OUD) in order to increase access to addiction treatment, it is not known what impact such training and subsequent experience treating patients with OUD has on full agonist opioid prescribing.
This retrospective cohort study compares the full agonist opioid prescribing patterns of Drug Addiction Treatment Act (DATA)-waivered ("X-waivered") primary care clinicians to non-trained, non-waivered clinicians in a rural health network. X-waivered clinicians also received Project ECHO training and telementoring support for one year. Using prescriber data generated by an electronic medical record system, opioid prescribing and morphine milligram equivalents (MME) per day per patient were calculated. A between-group analysis was used to compare the study groups six months pre-versus post-training.
Although the mean number of full agonist opioid prescriptions per clinician and per 100 patient encounters decreased among all clinicians, there was no change in full agonist opioid prescribing MME. As expected, buprenorphine prescribing by X-waivered, trained clinicians increased significantly post-training.
: X-waivers plus Project ECHO support for the treatment of OUD using buprenorphine had no effect on full agonist opioid prescribing by primary care clinicians.
虽然初级保健临床医生正在接受使用丁丙诺啡治疗阿片类药物使用障碍(OUD)的培训,以增加成瘾治疗的可及性,但尚不清楚这种培训以及随后治疗 OUD 患者的经验对全激动剂阿片类药物的处方有什么影响。
这项回顾性队列研究比较了农村医疗网络中接受药物滥用治疗法(DATA)豁免(“X 豁免”)的初级保健临床医生与未经培训、未豁免的临床医生的全激动剂阿片类药物处方模式。X 豁免的临床医生还接受了为期一年的 ECHO 项目培训和远程指导。使用电子病历系统生成的处方数据,计算了阿片类药物的处方和每天每患者的吗啡毫克当量(MME)。使用组间分析比较了培训前后六个月的研究组。
尽管所有临床医生的全激动剂阿片类药物处方数和每 100 名患者就诊的处方数平均值都有所下降,但全激动剂阿片类药物处方 MME 没有变化。正如预期的那样,X 豁免且接受培训的临床医生的丁丙诺啡处方量在培训后显著增加。
X 豁免加上使用丁丙诺啡治疗 OUD 的 ECHO 项目支持对初级保健临床医生的全激动剂阿片类药物处方没有影响。