Cole Evan S, Drake Coleman, DiDomenico Ellen, Sharbaugh Michael, Kim Joo Yeon, Nagy Dylan, Cochran Gerald, Gordon Adam J, Gellad Walid F, Pringle Janice, Warwick Jack, Chang Chung-Chou H, Kmiec Julie, Kelley David, Donohue Julie M
University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States.
University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States.
Drug Alcohol Depend. 2021 Apr 1;221:108633. doi: 10.1016/j.drugalcdep.2021.108633. Epub 2021 Feb 16.
Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses.
To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose.
Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data.
MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose.
Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches.
Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
许多患有阿片类药物使用障碍（OUD）的人在一家诊所开始接受阿片类药物使用障碍药物治疗（MOUD），并在治疗过程中转到另一家诊所。这些转诊可能是出于转诊目的或出于意外原因。然而，尚不清楚转至其他MOUD诊所对MOUD治疗的连续性或过量用药有何影响。
研究MOUD诊所转诊模式及其与MOUD覆盖天数比例（PDC）和阿片类药物相关过量用药的关联。
对宾夕法尼亚州医疗补助索赔数据进行横断面回顾性分析。
MOUD诊所转诊（即从与前一位开处方者所在诊所不同的开处方者处开具MOUD处方）、PDC和阿片类药物相关过量用药。
在14107名登记者中，43.2%的人在270天内至少有一次转至其他诊所接受MOUD治疗。在多变量回归结果中，非西班牙裔黑人登记者（发病率比值比[IRR]=1.43；95%置信区间[CI]=1.24-1.65；p<0.001）、曾使用过美沙酮的登记者（IRR=1.32；95%CI=1.13-1.55；p<0.001）以及门诊就诊总次数较多的登记者（IRR=1.01；CI=1.01-1.01；p<0.001）转诊次数更多。诊所转诊次数与PDC呈正相关（比值比[OR]=1.12；95%CI=1.10-1.13）。在二次分析中，我们发现仅因一次MOUD配药而转诊与较低的PDC相关（OR=0.97；95%CI=0.95-0.99），而因多次MOUD配药而转诊与较高的PDC相关（OR=1.40；95%CI=1.36-1.44）。我们未观察到阿片类药物相关过量用药与诊所转诊之间的关系。
就过量用药和PDC而言，接受MOUD时缺乏开处方者的连续性可能不像其他情况那样存在问题。
