Vakkalanka Jayamalathi Priyanka, Lund Brian C, Arndt Stephan, Field William, Charlton Mary, Ward Marcia M, Carnahan Ryan M
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Health Serv Res. 2022 Apr;57(2):392-402. doi: 10.1111/1475-6773.13919. Epub 2021 Dec 18.
To examine the extent to which there was any therapeutic relationship between Veterans and their initial buprenorphine provider and whether the presence of this relationship influenced treatment retention.
National, secondary administrative data used from the Veterans Health Administration (VHA), 2008-2017.
Retrospective cohort study. The primary exposure was a therapeutic relationship between the Veteran and buprenorphine provider, defined as the presence of a previous visit or medication prescribed by the provider in the 2 years preceding buprenorphine treatment initiation. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year.
DATA COLLECTION/EXTRACTION METHODS: Adult Veterans (age ≥ 18 years) diagnosed with opioid use disorder and treated with buprenorphine or buprenorphine/naloxone within the VHA system were included in this study. We excluded those receiving buprenorphine patches, those with documentation of a metastatic tumor diagnosis within 2 years prior to buprenorphine initiation, and those without geographical information on rurality.
A total of 28,791 Veterans were included in the study. Within the overall study sample, 56.3% (n = 16,206) of Veterans previously had at least one outpatient encounter with their initial buprenorphine provider, and 24.9% (n = 7174) of Veterans previously had at least one prescription from that provider in the 2 years preceding buprenorphine initiation. There was no significant or clinically meaningful association between therapeutic relationship history and treatment retention when defined as visit history (aHR: 0.99; 95% CI: 0.96, 1.02) or medication history (aHR: 1.03; 95% CI: 1.00, 1.07).
Veterans initiating buprenorphine frequently did not have a therapeutic history with their initial buprenorphine provider, but this relationship was not associated with treatment retention. Future work should investigate how the quality of Veteran-provider therapeutic relationships influences opioid use dependence management and whether eliminating training requirements for providers might affect access to buprenorphine, and subsequently, treatment initiation and retention.
探讨退伍军人与其最初的丁丙诺啡提供者之间存在何种治疗关系，以及这种关系的存在是否会影响治疗的持续性。
使用了退伍军人健康管理局（VHA）2008 - 2017年的全国性二级行政数据。
回顾性队列研究。主要暴露因素是退伍军人与丁丙诺啡提供者之间的治疗关系，定义为在开始丁丙诺啡治疗前2年内曾有过就诊或由该提供者开具过药物处方。主要结局是治疗中断，评估为从开始治疗到1年期间连续14天未用药。
数据收集/提取方法：本研究纳入了在VHA系统中被诊断为阿片类物质使用障碍并接受丁丙诺啡或丁丙诺啡/纳洛酮治疗的成年退伍军人（年龄≥18岁）。我们排除了接受丁丙诺啡贴片治疗的患者、在开始丁丙诺啡治疗前2年内有转移性肿瘤诊断记录的患者，以及没有农村地区地理信息的患者。
共有28,791名退伍军人纳入研究。在整个研究样本中，56.3%（n = 16,206）的退伍军人之前至少与他们最初的丁丙诺啡提供者有过一次门诊接触，24.9%（n = 7174）的退伍军人在开始丁丙诺啡治疗前2年内曾至少有过该提供者开具的一张处方。当将治疗关系历史定义为就诊历史（校正风险比：0.99；95%置信区间：0.96, 1.02）或用药历史（校正风险比：1.03；95%置信区间：1.00, 1.07）时，治疗关系历史与治疗持续性之间没有显著的或具有临床意义的关联。
开始使用丁丙诺啡的退伍军人通常与其最初的丁丙诺啡提供者没有治疗历史，但这种关系与治疗持续性无关。未来的工作应调查退伍军人与提供者之间治疗关系的质量如何影响阿片类物质使用依赖的管理，以及取消对提供者的培训要求是否会影响丁丙诺啡的获取，进而影响治疗的开始和持续性。
