Department of Family Medicine, Oregon Health & Science University (OHSU), United States of America.
Department of Family Medicine, Oregon Health & Science University (OHSU), United States of America.
J Subst Abuse Treat. 2021 Dec;131:108548. doi: 10.1016/j.jsat.2021.108548. Epub 2021 Jun 24.
Buprenorphine, a medication for opioid use disorder (OUD), can be administered within primary care; however, little is known about characteristics associated with retention on buprenorphine in these settings. This study examines patient correlates of buprenorphine retention and whether an integrated, interdisciplinary treatment model (buprenorphine and behavioral health) is associated with higher odds of buprenorphine retention than a primarily medication-only treatment model.
Electronic health record data from adult patients with an OUD, ≥1 buprenorphine order and ≥1 visit to either of two primary care clinics between 9/2/2014-6/27/2018 were extracted (N = 494 patients). Two research team members reviewed the medication start and stop dates for each buprenorphine order and classified as retained (≥6 months of orders) or not retained (<6 months of orders). Logistic regressions estimated the odds of retention on buprenorphine by 1) patient characteristics and 2) timing of patient's engagement in buprenorphine treatment (pre- or post-implementation of an integrated treatment model).
Of the study sample, 53% had ≥6 months of buprenorphine orders. Almost two times higher odds of retention were found among patients with ≥1 psychiatric comorbidity (versus none) and among those with buprenorphine orders in the post- versus pre-period.
An integrated, interdisciplinary model of OUD treatment was associated with ≥6 months of buprenorphine orders among our study population. Continued research is needed in real-world primary care settings to understand the impact of OUD treatment models on patient outcomes. A more nuanced examination of the associations between psychiatric diagnoses and buprenorphine treatment retention is warranted.
丁丙诺啡是一种阿片类药物使用障碍（OUD）的药物，可以在初级保健中使用；然而，对于在这些环境中保留丁丙诺啡的相关特征知之甚少。本研究检查了保留丁丙诺啡的患者特征，以及综合的、跨学科的治疗模式（丁丙诺啡和行为健康）是否比主要的药物治疗模式更有可能增加保留丁丙诺啡的几率。
从 2014 年 9 月 2 日至 2018 年 6 月 27 日期间，从两家初级保健诊所中患有 OUD、≥1 次丁丙诺啡处方和≥1 次就诊的成年患者的电子健康记录数据中提取数据（N=494 名患者）。两名研究小组成员审查了每个丁丙诺啡处方的开始和停止日期，并将其分类为保留（≥6 个月的处方）或不保留（<6 个月的处方）。通过 1）患者特征和 2）患者接受丁丙诺啡治疗的时间（在综合治疗模式实施前或后），逻辑回归估计了保留丁丙诺啡的几率。
在研究样本中，53%的患者有≥6 个月的丁丙诺啡处方。与没有精神共病（无）的患者相比，有≥1 种精神共病的患者和丁丙诺啡处方在后期（相对于前期）的患者保留丁丙诺啡的几率高近两倍。
在我们的研究人群中，OUD 治疗的综合、跨学科模式与≥6 个月的丁丙诺啡处方有关。需要在现实世界的初级保健环境中进一步研究，以了解 OUD 治疗模式对患者结局的影响。有必要更细致地研究精神诊断与丁丙诺啡治疗保留之间的关联。
