From the Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY (JDM, JS, MM, PY, KD, RC); and Broadalbin-Perth Family Health, Carondelet Regional Medical P.C., Broadalbin, NY (KC).
J Addict Med. 2022;16(6):716-721. doi: 10.1097/ADM.0000000000001009. Epub 2022 Aug 2.
Although primary care settings have benefits for implementing office-based opioid treatment (OBOT) programs with buprenorphine, few studies have examined the impact on patient retention beyond 12 months. The objective of this study is to assess long-term outcomes of buprenorphine treatment for opioid use disorder (OUD) integrated into comprehensive primary care treatment at a family medicine practice.
A retrospective chart review of patients diagnosed with OUD who received treatment with buprenorphine between December 2006 and January 2018 was conducted at private family medicine practice in semirural Upstate New York. Patients were seen continuously by the same provider. The primary outcome was retention in OBOT at 3 years.
The primary outcome was met by 47.4% of included patients (N = 152). Mean retention in care for all patients was 24.3 months. More than three quarters of patients (77%) had a least one psychiatric comorbidity managed by the practice, most commonly depression (59.9%). Self-reported history of intravenous drug use at baseline was associated with a higher likelihood of patient dropout at year 1 (odds ratio, 2.99; 95% confidence interval, 1.39-6.44; P = 0.004) and year 2 (odds ratio, 2.46; 95% confidence interval, 1.15-5.28; P = 0.019), with no difference observed at year 3.
Office-based opioid treatment with buprenorphine in a family medicine practice setting resulted in high retention rates, emphasizing the importance of continuity of care and integration of primary care within the OUD treatment model. Further research is needed on barriers to implementation of OBOT among family medicine providers.
尽管初级保健环境有利于实施以丁丙诺啡为基础的门诊阿片类药物治疗（OBOT）计划，但很少有研究检查其在 12 个月后对患者保留率的影响。本研究的目的是评估将丁丙诺啡治疗阿片类药物使用障碍（OUD）整合到家庭医学实践中的综合初级保健治疗中的长期结果。
对 2006 年 12 月至 2018 年 1 月期间在纽约州北部半农村地区的私人家庭医学实践中接受丁丙诺啡治疗的 OUD 患者的病历进行回顾性图表审查。患者由同一位提供者连续就诊。主要结果是 3 年内 OBOT 的保留率。
47.4%的纳入患者（N=152）达到了主要结果。所有患者的平均治疗保留时间为 24.3 个月。超过 3/4 的患者（77%）在实践中至少有一种精神共病得到管理，最常见的是抑郁（59.9%）。基线时自我报告的静脉药物使用史与患者在第 1 年（优势比，2.99；95%置信区间，1.39-6.44；P=0.004）和第 2 年（优势比，2.46；95%置信区间，1.15-5.28；P=0.019）的脱落可能性更高，但在第 3 年没有差异。
家庭医学实践中以丁丙诺啡为基础的门诊阿片类药物治疗导致了高保留率，这强调了连续性护理和将初级保健纳入 OUD 治疗模式的重要性。需要进一步研究家庭医学提供者实施 OBOT 的障碍。
