全州公共和私人保险中初级保健在阿片类药物使用障碍治疗启动中的作用。

The Role of Primary Care in the Initiation of Opioid Use Disorder Treatment in Statewide Public and Private Insurance.

机构信息

Department of Health Policy and Management, University of North Carolina at Chapel Hill, NC (AKG, JSR, MEH, CMS, MED); Department of Maternal and Child Health, University of North Carolina at Chapel Hill, NC (SLG); Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC (SLG, MED).

出版信息

J Addict Med. 2022;16(2):183-191. doi: 10.1097/ADM.0000000000000860.

DOI:10.1097/ADM.0000000000000860

PMID:33973922

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8578588/

Abstract

OBJECTIVE

To determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD).

METHODS

Observational study using logistic regression with claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017.

KEY RESULTS

Between 2014 and 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period, the percent of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. Of Medicaid enrollees receiving buprenorphine, the percent receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. Approximately 82% of people newly diagnosed with OUD had a PCP visit in the 12 months before diagnosis in Medicaid and private insurance. Those with a prior PCP visit were not more likely to receive MOUD. Seeing a PCP at diagnosis was associated with a higher probability of receiving MOUD than seeing an emergency provider but a lower probability than seeing a behavioral health specialist or other provider type.

CONCLUSIONS

People newly diagnosed with OUD had high rates of contact with PCPs before diagnosis, supporting the importance of PCPs in diagnosing OUD and connecting people to MOUD. Policies and programs to increase access to MOUD and improve PCPs' ability to connect people to evidence-based treatment are needed.

摘要

目的

确定在诊断日期之前或当天看过初级保健提供者（PCP）的新诊断为阿片类药物使用障碍（OUD）的个体，其 OUD 药物治疗（MOUD）的比率是否更高。

方法

使用来自北卡罗来纳州 Medicaid 和大型私人保险公司的索赔数据进行观察性研究，时间为 2014 年 1 月至 2017 年 7 月。

主要结果

在 2014 年至 2017 年期间， Medicaid 参保者中诊断出的 OUD 患病率增加了 47%，私人保险参保者中增加了 76%。同期，两组中接受 MOUD 的 OUD 患者比例均有所下降，而 PCP 参与治疗的比例有所上升。在接受丁丙诺啡的 Medicaid 参保者中，从 2014 年的 32%增加到 2017 年的 39%，接受 PCP 提供的丁丙诺啡的比例有所增加。在 Medicaid 和私人保险中，约有 82%的新诊断出的 OUD 患者在诊断前的 12 个月内有 PCP 就诊。有先前 PCP 就诊史的人不太可能接受 MOUD。在诊断时看 PCP 与接受 MOUD 的可能性较高，但与看急诊提供者相比可能性较低，与看行为健康专家或其他类型的提供者相比可能性较低。