Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, United States; Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, CA, United States.
Drug Alcohol Depend. 2021 May 1;222:108673. doi: 10.1016/j.drugalcdep.2021.108673. Epub 2021 Mar 18.
Medication for opioid use disorder (MOUD) using buprenorphine in primary or specialty care settings is accessed primarily by persons with private health insurance, stable housing, and no polysubstance use. This paper applies Social Cognitive Theory to frame links between social factors and treatment outcomes among patients with social and economic disadvantages who are seeking MOUD at California Bridge Program (CA Bridge) hospitals.
Electronic medical records for patients identified with OUD between January-April, 2020 receiving care at CA Bridge hospitals defined outcomes: hospital-administered buprenorphine; provision of buprenorphine prescription at discharge. Multi-level models assessed whether social factors-housing status, insurance type, and co-methamphetamine use-predicted outcomes while accounting for group-level effects of treating hospital and controlling for age, race/ethnicity, and gender.
15 CA Bridge hospitals yielded 845 patient records. Most patients received hospital-administered buprenorphine (58 %) and/or a buprenorphine prescription (55 %); 26 % received neither treatment. Patients with unstable housing had greater odds of hospital-administered buprenorphine compared to patients with stable housing. Patients with Medicaid had greater odds of receiving a buprenorphine prescription compared to patients with other insurance. Co-methamphetamine use was not associated with outcomes.
Patients with OUD are successful in accessing same-day MOUD in CA Bridge hospital settings over a significant period. Importantly, access to MOUD in these settings was facilitated for patients traditionally not treated using buprenorphine, i.e., those with housing instability, Medicaid insurance, and co-methamphetamine use. Findings suggest barriers to MOUD for patients with social and economic disadvantages can be lowered by changing treatment delivery.
在初级或专科医疗机构中使用丁丙诺啡治疗阿片类药物使用障碍（MOUD）的药物主要由有私人医疗保险、稳定住房和无多种药物使用的人获得。本文应用社会认知理论来构建在加利福尼亚桥项目（CA Bridge）医院寻求 MOUD 的社会经济劣势患者的社会因素与治疗结果之间的联系。
在 2020 年 1 月至 4 月期间，电子病历中记录了在 CA Bridge 医院接受 OUD 治疗的患者，确定了以下结果：医院管理的丁丙诺啡；出院时提供丁丙诺啡处方。多水平模型评估了住房状况、保险类型和共同使用甲基苯丙胺等社会因素是否预测了治疗医院的治疗结果，同时考虑了治疗医院的群体效应，并控制了年龄、种族/族裔和性别。
15 家 CA Bridge 医院共产生 845 份患者记录。大多数患者接受了医院管理的丁丙诺啡（58%）和/或丁丙诺啡处方（55%）；26%的患者未接受任何治疗。与稳定住房的患者相比，住房不稳定的患者接受医院管理的丁丙诺啡的可能性更大。与其他保险的患者相比，有医疗补助的患者接受丁丙诺啡处方的可能性更大。同时使用甲基苯丙胺与结果无关。
在 CA Bridge 医院环境中，患有 OUD 的患者在相当长的一段时间内成功获得了当天的 MOUD。重要的是，在这些环境中，获得 MOUD 对那些传统上未使用丁丙诺啡治疗的患者变得更加容易，例如那些住房不稳定、有医疗补助保险和同时使用甲基苯丙胺的患者。研究结果表明，通过改变治疗方式，可以降低社会经济劣势患者接受 MOUD 的障碍。
