Phoenix VA Health Care System, Phoenix, AZ, USA.
VA St. Louis Health Care System, St. Louis, MO, USA.
Am J Health Syst Pharm. 2021 Feb 8;78(4):301-309. doi: 10.1093/ajhp/zxaa386.
PURPOSE: The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. METHODS: A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. RESULTS: One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. CONCLUSION: Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.
目的：评估集中住院教育干预对接受阿片类药物使用障碍（OUD）治疗的退伍军人药物辅助治疗（MAT）率的影响。
方法：回顾性队列分析比较了接受 OUD 诊断的退伍军人在实施一系列旨在激发改变阿片类药物滥用行为的内在动机并提供 MAT 教育的小组会议前后，MAT 率以及在 1 年内 OUD 相关急诊就诊和/或住院率，这些退伍军人完成了住院康复治疗（对照组）和在实施教育计划后完成康复治疗的退伍军人（干预组）。进行了事后多变量分析，以评估 MAT 使用和 ED 和/或医院再入院的可能预测因素，包括完成阿片类系列、性别、年龄（>45 岁）、种族和特定的先前滥用物质。
结果：共纳入 158 例患者：对照组 95 例，干预组 63 例。对照组 MAT 使用率为 25%（95 例中的 24 例），干预组为 75%（63 例中的 47 例）（P<0.01）。性别、完成阿片类系列、既往海洛因使用和大麻使用符合纳入多变量回归模型以关联 MAT 使用率的预设显著性标准，参与阿片类系列（优势比[OR]，9.56；95%置信区间[CI]，4.36-20.96）和既往海洛因使用（OR，3.26；95% CI，1.18-9.01）被发现是 MAT 使用率的多变量分析中的显著预测因素。阿片类系列的参与和 MAT 的使用与 OUD 相关 ED 就诊和/或住院率降低独立相关（康复完成后 1 年内 OUD 相关 ED 就诊和/或住院率的风险比分别为 0.16（95% CI，0.06-0.44）和 0.32（95% CI，0.14-0.77））。
结论：在 OUD 退伍军人的药物滥用项目中进行集中 OUD 相关教育增加了 MAT 的使用率，并与康复后 1 年内 OUD 相关 ED 就诊和/或住院率降低相关。
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