National Institute on Drug Abuse, Rockville, Maryland, and Department of Health Policy and Management, George Washington University, Washington, D.C. (Jones); Department of Medicine, University of Chicago, Chicago (Staab, Wan, Quinn, Chin, Laiteerapong); Dunigan Family Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana (Schaefer); MidMichigan Community Health Services, Houghton Lake, Michigan (Gedeon); Midwest Clinicians' Network, East Lansing, Michigan (Campbell).
Psychiatr Serv. 2020 Jul 1;71(7):684-690. doi: 10.1176/appi.ps.201900409. Epub 2020 May 22.
Expanding access to addiction screening and treatment in primary care, particularly in underserved communities, is a key part of the fight against the opioid epidemic. This study explored correlates of addiction treatment capacity in federally qualified health centers participating in the Midwest Clinicians' Network (MWCN).
Two surveys were fielded to 132 MWCN health centers: the Health Center Survey and the Behavioral Health and Diabetes Provider Survey. A total of 77 centers and 515 primary care clinicians, respectively, responded to the surveys. Data were combined with data from the 2016 Uniform Data System and information about receipt of targeted Health Resources and Services Administration (HRSA) grant funding for addiction treatment capacity. Multivariable models examined associations between Medicaid reimbursement for addiction services, HRSA targeted grant funding, and different types of on-site addiction treatment capacity: psychiatrist and certified addiction counselor staffing, addiction counseling services, and medication-assisted treatment (MAT) for opioid addiction.
Health centers that received Medicaid behavioral health reimbursement were five times as likely as those that did not to offer addiction counseling and to employ certified addiction counselors. Health centers that received targeted HRSA funding for addiction services were more than 20 times as likely as those that did not to provide MAT and more than three times as likely to employ psychiatrists. Training needs and privacy protections on data related to addiction treatment were cited as barriers to building addiction treatment capacity.
Medicaid funding and targeted grant funding were associated with addiction treatment capacity in health centers.
在初级保健中扩大对成瘾筛查和治疗的获取，特别是在服务不足的社区，这是对抗阿片类药物流行的关键部分。本研究探讨了参与中西部临床医生网络（MWCN）的合格联邦健康中心的成瘾治疗能力的相关因素。
向 132 个 MWCN 健康中心发送了两份调查：健康中心调查和行为健康和糖尿病提供者调查。共有 77 个中心和 515 名初级保健临床医生分别对调查做出了回应。数据与 2016 年统一数据系统的数据以及关于接受针对成瘾治疗能力的特定卫生资源和服务管理局（HRSA）赠款资金的信息相结合。多变量模型研究了成瘾服务的 Medicaid 报销、HRSA 针对性赠款资金以及不同类型的现场成瘾治疗能力之间的关联：精神科医生和认证成瘾顾问人员配备、成瘾咨询服务以及阿片类药物成瘾的药物辅助治疗（MAT）。
接受 Medicaid 行为健康报销的健康中心提供成瘾咨询服务和雇佣认证成瘾顾问的可能性是未接受者的五倍。接受针对成瘾服务的 HRSA 赠款资金的健康中心提供 MAT 的可能性是未接受者的 20 多倍，雇佣精神科医生的可能性是未接受者的三倍多。培训需求和与成瘾治疗相关数据的隐私保护被认为是建立成瘾治疗能力的障碍。
医疗补助资金和有针对性的赠款资金与健康中心的成瘾治疗能力相关。
