Medical student, Yale School of Medicine, New Haven, Connecticut.
Center for Emergency Care and Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2020 Dec 1;3(12):e2029043. doi: 10.1001/jamanetworkopen.2020.29043.
The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone.
To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list.
State-level NAS incidence and county-level uninsured rates and rurality.
Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine.
Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of ≥20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007).
Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients' access to buprenorphine, especially during pregnancy.
怀孕期间阿片类药物的使用发生率正在上升，药物过量是产后死亡的主要原因。尽管这些药物能带来死亡率的降低，但大多数怀孕的女性并没有接受治疗阿片类药物使用障碍的药物，尽管这些药物能带来死亡率的降低。此外，与美沙酮相比，丁丙诺啡与新生儿戒断综合征（NAS）的症状较轻有关。
描述 2019 年美国能够开具丁丙诺啡处方的妇产科医生（以下简称 X 豁免医生）的流行率和地理分布情况。
设计、地点和参与者：一项全国性的横断面研究，将医生特定数据与县和州级数据进行了关联，研究从 2019 年 9 月 1 日至 2020 年 3 月 31 日进行。从医疗保险服务中心医师比较数据集中获得了 31211 名接受医疗补助保险的妇产科医生的数据，并与药物滥用治疗法丁丙诺啡豁免临床医生名单进行了关联。
州级 NAS 发病率、县级未参保率和农村地区。
接受丁丙诺啡处方培训的妇产科医生的流行率和地理分布情况。
在所确定的 31211 名妇产科医生中，18710 名（59.9%）为女性。大多数医生都有医院特权（23236 人[74.4%]），在大都市县工作（28613 人[91.7%]）。只有 560 名（1.8%）被识别的妇产科医生是 X 豁免医生。在未参保居民少于 5%的县，成为 X 豁免医生的可能性几乎是未参保居民超过 15%的县的两倍（调整后的优势比[OR]，1.59；95%CI，1.04-2.44；P=0.04）。与位于大都市县的医生相比，位于郊区县（如城市人口≥20000 人且毗邻大都市地区）的妇产科医生更有可能成为 X 豁免医生（调整后的 OR，1.85；95%CI，1.26-2.71；P=0.002）。与 NAS 发病率为每 1000 例活产 5 例或以下的州相比，NAS 发病率为每 1000 例活产 15 例或以上的州的妇产科医生成为 X 豁免医生的可能性几乎是前者的 5 倍（调整后的 OR，4.94；95%CI，3.60-6.77；P<0.001）。没有医院特权的妇产科医生更有可能成为 X 豁免医生（调整后的 OR，1.32；95%CI，1.08-1.61；P=0.007）。
接受医疗补助的妇产科医生中，只有不到 2%的人能够开具丁丙诺啡处方，而且他们的地理分布似乎偏向于郊区县。这一发现表明，卫生系统和专业协会有机会激励妇产科医生接受 X 豁免培训，以增加患者获得丁丙诺啡的机会，特别是在怀孕期间。
