澳大利亚新南威尔士州 2001-2018 年阿片类激动剂治疗处方医生保留情况：对治疗系统的影响及对患者结局的潜在影响。

Retention of opioid agonist treatment prescribers across New South Wales, Australia, 2001-2018: Implications for treatment systems and potential impact on client outcomes.

机构信息

National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia.

Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, Australia.

出版信息

Drug Alcohol Depend. 2021 Feb 1;219:108464. doi: 10.1016/j.drugalcdep.2020.108464. Epub 2020 Dec 19.

DOI:10.1016/j.drugalcdep.2020.108464

PMID:33360851

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7855715/

Abstract

BACKGROUND

There has been much research on the efficacy and effectiveness of opioid agonist treatment (OAT), but less on its implementation and sustainability. A challenge internationally has been recruiting and retaining prescribers. This paper aims to characterise the prescribers in terms of OAT prescribing behaviours.

METHODS

Retrospective cohort study in New South Wales, Australia. Participants were 2199 OAT prescribers between 1 st August 2001-19th September 2018.We examined trends in initiation and cessation of OAT prescribers. Adjusted hazard ratios were calculated to estimate prescriber retention, adjusting for year of initiation, practice type, client load and treatment prescribed.

RESULTS

The rate of prescribers ceasing OAT prescribing has been increasing over time: a prescriber who initiated between 2016-2017 had over four times the risk of cessation compared with one who initiated before 2001, AHR: 4.77; [3.67-6.21]. The highest prescriber cessation rate was in prescribers who had prescribed for shorter time periods. The annual percentage of prescribers who ceased prescribing among those who prescribed for ≤5 years increased from 3% in 2001 to 20 % in 2017. By 2017 more prescribers were discontinuing prescribing than new prescribers were starting. Approximately 87 % (n = 25,167) of OAT clients were under the care of 20 % of OAT prescribers (n = 202); half had been prescribing OAT for 17+ years.

CONCLUSIONS

OAT prescribing is increasingly concentrated in a small group of mature prescribers, and new prescribers are not being retained. There is a need to identify and respond to the reasons that contribute to newer prescribers to cease prescribing and put in place strategies to increase retention and broaden the base of doctors involved in such prescribing.

摘要

背景

已有大量研究探讨了阿片类激动剂治疗（OAT）的疗效和有效性，但对其实施和可持续性的研究较少。国际上的一个挑战是招募和留住开处方者。本文旨在从 OAT 处方行为的角度描述这些开处方者。

方法

这是澳大利亚新南威尔士州的一项回顾性队列研究。参与者为 2001 年 8 月 1 日至 2018 年 9 月 19 日期间的 2199 名 OAT 开处方者。我们研究了 OAT 开处方者开始和停止的趋势。调整后的危险比用于估计开处方者保留率，调整了起始年份、实践类型、患者量和所开处方的治疗药物。

结果

OAT 处方的开处方者停止开处方的比例随着时间的推移一直在增加：与 2001 年前开始的开处方者相比，2016-2017 年开始的开处方者停止开处方的风险高出四倍以上，调整后的危险比为 4.77；[3.67-6.21]。开处方时间较短的开处方者的处方终止率最高。在开处方时间≤5 年的开处方者中，每年停止开处方的比例从 2001 年的 3%增加到 2017 年的 20%。到 2017 年，停止开处方的开处方者多于开始开处方的新开处方者。大约 87%（n=25167）的 OAT 患者由 20%的 OAT 开处方者（n=202）照顾；其中一半的人已经开 OAT 处方 17 年以上。