J Am Pharm Assoc (2003). 2021 Sep-Oct;61(5):589-595. doi: 10.1016/j.japh.2021.04.014. Epub 2021 Apr 24.
Not all pharmacies stock and dispense buprenorphine, potentially complicating continuous access to care for patients with opioid use disorder (OUD). This may become problematic if a patient's primary pharmacy can no longer provide buprenorphine, and the patient cannot locate a new pharmacy.
To identify how often patients treated with buprenorphine for OUD switch pharmacies and to estimate the association between switching pharmacies and a clinically significant gap in therapy of 7 days or longer.
A retrospective repeated measures longitudinal cohort design was used. Patients initiating treatment with a buprenorphine product indicated for OUD were identified from the 2016-2018 Texas Prescription Monitoring Program. The predictor of interest-switching pharmacies-was defined by comparing the dispensaries used between subsequent prescriptions. The outcome of interest was defined as a gap in medication possession of 7 days or longer on the basis of the National Quality Forum's definition of continuity of pharmacotherapy for OUD. A generalized estimating equation approach was used to estimate a repeated measures logistic regression measuring the association between switching pharmacies and a gap in therapy.
Of 13,375 eligible patients, 29.6% switched pharmacies at least once during treatment, and 51.6% of these did so more than once. The median time to initial switch was 30 days (interquartile range: 13-66 days). When patients switched pharmacies, they were significantly more likely to have a gap in therapy of between 7 and 29 days (adjusted odds ratio 1.67 [95% CI 1.57-1.78]).
Patients receiving buprenorphine switch pharmacies early and frequently in treatment, which leads to clinically significant gaps in therapy. Although qualitative explanatory work is needed to understand why patients switch pharmacies so often, pharmacists and prescribers must ensure that patients have reliable access to a convenient source of buprenorphine to prevent gaps in therapy.
并非所有的药店都储备和配发丁丙诺啡，这可能会使阿片类药物使用障碍（OUD）患者的连续治疗变得复杂。如果患者的主要药店无法再提供丁丙诺啡，而患者又找不到新的药店，这可能会成为一个问题。
确定接受丁丙诺啡治疗 OUD 的患者换用药店的频率，并估计换用药店与治疗中断 7 天或更长时间的临床显著差距之间的关联。
采用回顾性重复测量纵向队列设计。从 2016-2018 年德克萨斯州处方监测计划中确定了接受丁丙诺啡治疗 OUD 的患者。感兴趣的预测因素（换用药店）通过比较后续处方中使用的配药处来定义。感兴趣的结果定义为根据国家质量论坛（National Quality Forum）对 OUD 药物治疗连续性的定义，药物使用存在 7 天或更长时间的缺口。采用广义估计方程方法，估计重复测量逻辑回归模型，以衡量换用药店与治疗中断之间的关联。
在 13375 名符合条件的患者中，29.6%的患者在治疗过程中至少换过一次药店，其中 51.6%的患者换过不止一次。首次换用药店的中位时间为 30 天（四分位距：13-66 天）。当患者换用药店时，他们更有可能出现 7-29 天的治疗中断（调整后的优势比 1.67[95%置信区间 1.57-1.78]）。
接受丁丙诺啡治疗的患者在治疗过程中很早就开始频繁换用药店，这导致了治疗中断的临床显著差距。虽然需要进行定性解释性工作来了解为什么患者如此频繁地换用药店，但药剂师和处方医生必须确保患者能够可靠地获得方便的丁丙诺啡来源，以防止治疗中断。
