Saunders Heather, Britton Erin, Cunningham Peter, Saxe Walker Lauryn, Harrell Ashley, Scialli Anna, Lowe Jason
Department of Health Behavior and Policy, Virginia Commonwealth University, United States of America.
Department of Health Behavior and Policy, Virginia Commonwealth University, United States of America.
J Subst Abuse Treat. 2022 Feb;133:108513. doi: 10.1016/j.jsat.2021.108513. Epub 2021 Jun 1.
This study examines Medicaid participation among buprenorphine waivered providers in Virginia in 2019, with a particular focus on the prescribing differences between different physician specialties, nurse practitioners and physicians assistants (NP and PA).
Secondary data sources include the 2019 DEA list of buprenorphine waivered prescribers, Virginia Medicaid claims for buprenorphine, physician characteristics from the Virginia Department of Health Professions, SAMHSA Behavioral Treatment Services Locator, and area level characteristics. This cross-sectional study is based on a linkage of Medicaid claims data to a list of Virginia practitioners authorized to prescribe buprenorphine in 2019. Using a two-part logistic regression, we assess prescriber license type and local area factors that are associated with: (1) the probability of prescribing buprenorphine to any Medicaid patients in 2019; (2) the number of Medicaid patients treated by each prescriber in 2019.
Adjusted odds ratios show that nurse practitioners with buprenorphine waivers are more likely to treat any Medicaid patients compared to physicians (odds ratio (OR), 2.016; p = 0.000). Among prescribers who treated any Medicaid patients, the probability of treating a large number of Medicaid patients was higher among nurse practitioners relative to physicians (OR, 2.869, p = 0.002). Medicaid participation was much higher among prescribers with patient limits of 100 and 275 compared to prescribers with patient limits of 30 (OR, 6.66, p = 0.000 and 29.40, p = 0.000, respectively).
State Medicaid programs have been at the forefront of addressing their state's opioid epidemic, including expanding access to buprenorphine treatment. This study provides evidence that targeted outreach efforts should include NP license types as well as physicians, and is consistent with prior studies showing that NP are especially important in filling treatment gaps for underserved areas and populations.
本研究调查了2019年弗吉尼亚州获得丁丙诺啡豁免权的医疗服务提供者参与医疗补助计划的情况，特别关注不同医生专业、执业护士和医师助理（NP和PA）之间的处方差异。
二手数据来源包括2019年获得丁丙诺啡豁免权的处方医生的DEA名单、弗吉尼亚州医疗补助计划中丁丙诺啡的报销申请、弗吉尼亚州卫生职业部的医生特征、药物滥用和精神健康服务管理局行为治疗服务定位器以及地区层面特征。这项横断面研究基于将医疗补助计划报销数据与2019年弗吉尼亚州授权开具丁丙诺啡的从业者名单进行关联。使用两部分逻辑回归，我们评估与以下方面相关的处方医生执照类型和当地因素：（1）2019年向任何医疗补助计划患者开具丁丙诺啡的概率；（2）2019年每位处方医生治疗的医疗补助计划患者数量。
调整后的优势比表明，与医生相比，获得丁丙诺啡豁免权的执业护士更有可能治疗任何医疗补助计划患者（优势比（OR），2.016；p = 0.000）。在治疗了任何医疗补助计划患者的处方医生中，执业护士治疗大量医疗补助计划患者的概率相对于医生更高（OR，2.869，p = 0.002）。与患者限制为30人的处方医生相比，患者限制为100人和275人的处方医生参与医疗补助计划的比例要高得多（分别为OR，6.66，p = 0.000和29.40，p = 0.000）。
州医疗补助计划在应对本州的阿片类药物流行方面一直处于前沿，包括扩大丁丙诺啡治疗的可及性。本研究提供了证据表明，有针对性的外展工作应包括NP执照类型以及医生，并且与先前的研究一致，先前研究表明NP在填补服务不足地区和人群的治疗缺口方面尤为重要。
