与新诊断为阿片类药物使用障碍患者的临床医生治疗建议相关的因素。

Factors associated with clinician treatment recommendations for patients with a new diagnosis of opioid use disorder.

机构信息

VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.

Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI, United States of America; Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI, United States of America.

出版信息

J Subst Abuse Treat. 2022 Oct;141:108827. doi: 10.1016/j.jsat.2022.108827. Epub 2022 Jun 16.

DOI:10.1016/j.jsat.2022.108827

PMID:35863212

Abstract

BACKGROUND

This study examined factors associated with treatment recommendations for patients with a new diagnosis of opioid use disorder (OUD), comparing recommendations for patients with clear signs of OUD versus those with lower likelihood of OUD.

METHODS

The study conducted a retrospective medical chart review in a randomly selected national sample of 520 Veteran Health Administration patients with a new opioid-related electronic health record (EHR) diagnosis from 2012 to 2017. The study categorized patients as having "high likelihood" or "lower likelihood of OUD" based on the presence or absence of clinician documentation in medical records of specific qualifying criteria (e.g., clinician documentation of patient meeting diagnostic criteria for OUD, etc). Analyses examined the association between baseline demographic and clinical characteristics with recommendations for medication and other treatments for OUD.

RESULTS

Among patients with a new diagnosis of OUD, 28.7 % (n = 149) were recommended medication treatment, 52.5 % (n = 273) were recommended specialty substance use disorder (SUD) treatment, and 41.9 % (n = 218) were recommended treatment in non-SUD mental health settings. In adjusted models, high likelihood of OUD (AOR 8.31, 95 % CI 4.81-15.03) was strongly associated with the clinician recommending medications for OUD, while age 56-75 (compared to <35, AOR 0.36, 95 % CI 0.18-0.69), stimulant use disorder (AOR 0.28, 95 % CI 0.15-0.53), and rural residence (AOR 0.51, 95 % CI 0.30-0.85) were associated with lower likelihood of being recommended medication treatment.

CONCLUSIONS

Differentiating among patients with EHR diagnoses of OUD to identify the subset with higher likelihood of underlying OUD is important to accurately understand OUD treatment rates and disparities. However, even among patients with a clear diagnosis of OUD, medication treatment is still recommended less often than other treatments, suggesting interventions are needed to encourage clinicians to prioritize medication treatment as a first-line treatment, especially for older, rural patients and those with polysubstance use.

摘要

背景

本研究旨在比较有明确阿片类使用障碍（OUD）迹象的患者和不太可能患有 OUD 的患者的治疗建议，以探讨与新诊断为 OUD 的患者治疗建议相关的因素。

方法

本研究对 2012 年至 2017 年间，从退伍军人健康管理局（VHA）中随机选择的 520 名有新的阿片类相关电子健康记录（EHR）诊断的患者的医疗记录进行了回顾性医学图表审查。研究根据医疗记录中是否有特定资格标准的临床医生记录（例如，临床医生记录患者符合 OUD 的诊断标准等），将患者分为“高可能性”或“较低可能性 OUD”。分析研究了基线人口统计学和临床特征与 OUD 药物和其他治疗建议之间的关系。

结果

在新诊断为 OUD 的患者中，28.7%（n=149）被建议接受药物治疗，52.5%（n=273）被建议接受专业药物使用障碍（SUD）治疗，41.9%（n=218）被建议在非 SUD 心理健康机构接受治疗。在调整后的模型中，高 OUD 可能性（AOR 8.31，95%CI 4.81-15.03）与临床医生建议 OUD 药物治疗强烈相关，而年龄 56-75 岁（与 <35 岁相比，AOR 0.36，95%CI 0.18-0.69）、兴奋剂使用障碍（AOR 0.28，95%CI 0.15-0.53）和农村居住（AOR 0.51，95%CI 0.30-0.85）与较低的药物治疗推荐可能性相关。

结论

区分 EHR 诊断为 OUD 的患者，以确定更有可能患有 OUD 的亚组，对于准确了解 OUD 治疗率和差异非常重要。然而，即使在有明确 OUD 诊断的患者中，药物治疗的推荐频率仍低于其他治疗方法，这表明需要采取干预措施，鼓励临床医生将药物治疗作为一线治疗方法，特别是针对老年、农村患者和多药物使用患者。