Hasan Md Mahmudul, Noor-E-Alam Md, Shi Jiesheng, Young Leonard D, Young Gary J
Department of Mechanical and Industrial Engineering, College of Engineering, Center for Health Policy and Healthcare Research, Northeastern University, Boston, MA, USA.
Department of Mechanical and Industrial Engineering, College of Engineering, Northeastern University, Boston, MA, USA.
Am J Drug Alcohol Abuse. 2022 Jul 4;48(4):481-491. doi: 10.1080/00952990.2022.2065638. Epub 2022 Jun 7.
While buprenorphine/naloxone (buprenorphine) has been demonstrated to be an effective medication for treating opioid use disorder (OUD), an important question exists about how long patients should remain in treatment. To examine the relationship between treatment duration and patient outcomes for individuals with OUD who have been prescribed buprenorphine. We conducted a retrospective, longitudinal study using the Massachusetts All Payer Claims Database, 2013 to 2017. The study comprised over 2,500 patients, approximately one-third of whom were female, who had been prescribed buprenorphine for OUD. The outcomes were hospitalizations and emergency room (ER) visits at 36 months following treatment initiation and 12 months following treatment discontinuation. Patients were classified into four groups based on treatment duration and medication adherence: poor adherence, duration <12 months; good adherence, duration <6 months; good adherence, duration 6 to 12 months, and good adherence, duration >12 months. We conducted analyses at the patient level of the relationship between duration and outcomes. Better outcomes were observed for patients whose duration was greater than 12 months. Patients in the other groups had higher odds of hospitalization at 36 months following treatment initiation: poor adherence (2.71), <6 months (1.53), and 6 to 12 months (1.42). They also had higher odds of ER visits: poor adherence (1.69), <6 months (1.51), and 6 to 12 months (1.30). Similar results were observed following treatment discontinuation. OUD treatment with buprenorphine should be continued for at least 12 months to reduce hospitalizations and ED visits.
虽然丁丙诺啡/纳洛酮（丁丙诺啡）已被证明是治疗阿片类物质使用障碍（OUD）的有效药物，但关于患者应接受多长时间的治疗仍存在一个重要问题。为了研究接受丁丙诺啡治疗的OUD患者的治疗持续时间与患者预后之间的关系。我们使用2013年至2017年的马萨诸塞州全付费者索赔数据库进行了一项回顾性纵向研究。该研究包括2500多名患者，其中约三分之一为女性，她们因OUD而被开了丁丙诺啡。结局指标为治疗开始后36个月以及治疗中断后12个月的住院率和急诊室（ER）就诊率。根据治疗持续时间和药物依从性将患者分为四组：依从性差，持续时间<12个月；依从性好，持续时间<6个月；依从性好，持续时间6至12个月，以及依从性好，持续时间>12个月。我们在患者层面分析了持续时间与结局之间的关系。观察到持续时间大于12个月的患者预后更好。其他组的患者在治疗开始后36个月的住院几率更高：依从性差（2.71）、<6个月（1.53）和6至12个月（1.42）。他们的急诊室就诊几率也更高：依从性差（1.69）、<6个月（1.51）和6至12个月（1.30）。治疗中断后也观察到了类似结果。使用丁丙诺啡进行OUD治疗应持续至少12个月，以减少住院和急诊就诊次数。
