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Drug Alcohol Depend. 2021 Nov 1;228:109089. doi: 10.1016/j.drugalcdep.2021.109089. Epub 2021 Sep 22.
Many active buprenorphine prescribers treat few patients monthly, but little information is available regarding how prescribers' buprenorphine caseload fluctuates over time or how long it takes new prescribers to reach higher patient caseloads. We examine buprenorphine-prescribing clinicians' patient caseloads over time and explore prescriber characteristics associated with different caseload trajectories.
Using 2006-2018 national buprenorphine pharmacy claims, we calculate monthly patient caseloads for buprenorphine prescribers for 6 years following a clinician's first filled buprenorphine prescription. We use K-means clustering to identify clusters of clinician caseload trajectories and bivariate analyses to examine prescriber and county characteristics associated with different trajectory classes.
We identified 42,067 buprenorphine prescribers with 3 trajectory classes. High-volume (1.4%;n = 571) whose mean monthly patient caseload increased to approximately 40 patients through the initial 20 months and stabilized at 40 or more patients; moderate-volume (9.2%;n = 3891) whose mean patient caseload increased during the initial 20 months, stabilizing at 15-20 patients; and low-volume (89.4%;n = 37,605), who typically had fewer than 5 patients monthly. Most low-volume prescribers (n = 31,470; 83.7% of all prescribers) initially treated 1-2 patients for several months, followed by no subsequent prescribing.
Almost three-quarters of buprenorphine prescribers treated no more than a few patients for several months before ceasing buprenorphine prescribing; only 10% of prescribers averaged more than 10 patients per month over the next 6 years. Efforts are needed to identify factors contributing to prescribers being willing to continue prescribing buprenorphine over time and to prescribe to more patients in order to increase access to buprenorphine treatment.
许多活跃的丁丙诺啡开方医生每月治疗的患者很少，但关于开方医生丁丙诺啡患者人数随时间的波动情况，以及新医生需要多长时间才能达到更高的患者人数，相关信息有限。我们研究了丁丙诺啡开方医生随时间推移的患者人数，并探讨了与不同人数轨迹相关的开方医生特征。
使用 2006-2018 年全国丁丙诺啡药房报销数据，我们计算了每位丁丙诺啡开方医生在首次开具丁丙诺啡处方后的 6 年内每月的患者人数。我们使用 K-均值聚类法来识别开方医生人数轨迹的聚类，并使用双变量分析来研究与不同轨迹类别的开方医生和县级特征相关的因素。
我们确定了 42067 名丁丙诺啡开方医生，分为 3 个人数轨迹类别。高数量（1.4%；n=571）的开方医生每月患者人数最初增加到约 40 人，并在最初 20 个月内稳定在 40 人或更多；中数量（9.2%；n=3891）的开方医生每月患者人数在最初 20 个月内增加，稳定在 15-20 人；低数量（89.4%；n=37605）的开方医生每月通常不到 5 人。大多数低数量的开方医生（n=31470；所有开方医生的 83.7%）最初治疗 1-2 名患者几个月，然后停止开方。
近四分之三的丁丙诺啡开方医生在停止丁丙诺啡处方之前，几个月内治疗的患者人数不超过几个；在接下来的 6 年内，只有 10%的开方医生每月平均治疗 10 名以上的患者。需要努力确定促使开方医生愿意随着时间的推移继续开丁丙诺啡处方并为更多患者开方的因素，以增加丁丙诺啡治疗的可及性。
