Center for Health Policy Research, University of California, Los Angeles (UCLA), Los Angeles, CA, United States of America.
Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America.
PLoS One. 2020 Nov 30;15(11):e0242407. doi: 10.1371/journal.pone.0242407. eCollection 2020.
The opioid epidemic and subsequent mortality is a national concern in the U.S. The burden of this problem is disproportionately high among low-income and uninsured populations who are more likely to experience unmet need for substance use services. We assessed the impact of two Health Resources and Services Administration (HRSA) substance use disorder (SUD) service capacity grants on SUD staffing and service use in HRSA -funded health centers (HCs).
We conducted cross-sectional analyses of the Uniform Data System (UDS) from 2010 to 2017 to assess HC (n = 1,341) trends in capacity measured by supply of SUD and medication-assisted treatment (MAT) providers, utilization of SUD and MAT services, and panel size and visit ratio measured by the number of patients seen and visits delivered by SUD and MAT providers. We merged mortality and national survey data to incorporate SUD mortality and SUD treatment services availability, respectively. From 2010 to 2015, 20% of HC organizations had any SUD staff, had an average of one full-time equivalent SUD employee, and did not report an increase in SUD patients or SUD services. SUD capacity grew significantly in 2016 (43%) and 2017 (22%). MAT capacity growth was measured only in 2016 and 2017 and grew by 29% between those years. Receipt of both supplementary grants increased the probability of any SUD capacity by 35% (95% CI: 26%, 44%) and service use, but decreased the probability of SUD visit ratio by 680 visits (95% CI: -1,013, -347), compared to not receiving grants.
The significant growth in HC specialized SUD capacity is likely due to supplemental SUD-specific HRSA grants and may vary by structure of grants. Expanding SUD capacity in HCs is an important step in increasing SUD access for low income and uninsured populations broadly and for patients of these organizations.
阿片类药物流行及其导致的死亡率是美国的一个全国性问题。在低收入和没有保险的人群中，这一问题的负担不成比例地高，他们更有可能无法获得药物使用服务。我们评估了两个卫生资源和服务管理局（HRSA）物质使用障碍（SUD）服务能力赠款对 HRSA 资助的健康中心（HC）中 SUD 人员配备和服务使用的影响。
我们对 2010 年至 2017 年的统一数据系统（UDS）进行了横断面分析，以评估 HC（n=1341）中 SUD 和药物辅助治疗（MAT）提供者供应、SUD 和 MAT 服务使用、以及 SUD 和 MAT 提供者提供的就诊人数和就诊次数所衡量的面板大小和就诊比的趋势。我们合并了死亡率和全国性调查数据，分别纳入 SUD 死亡率和 SUD 治疗服务的可及性。从 2010 年到 2015 年，20%的 HC 组织有任何 SUD 工作人员，平均有一个全职当量 SUD 员工，并且没有报告 SUD 患者或 SUD 服务的增加。2016 年（43%）和 2017 年（22%）SUD 能力显著增长。MAT 能力增长仅在 2016 年和 2017 年进行了测量，这两年间增长了 29%。接受这两项补充赠款使获得任何 SUD 能力的可能性增加了 35%（95%CI：26%，44%），并增加了服务的使用，但使 SUD 就诊率的可能性降低了 680 次就诊（95%CI：-1013，-347），与未获得赠款相比。
HC 专门 SUD 能力的显著增长可能是由于补充了特定于 SUD 的 HRSA 赠款，并且可能因赠款结构而异。扩大 HC 中的 SUD 能力是增加低收入和没有保险的人群以及这些组织的患者获得 SUD 服务的重要步骤。
