Unity Health Toronto (Gomes, Antoniou); ICES (Gomes, McCormack, Kitchen, Antoniou); Leslie Dan Faculty of Pharmacy (Gomes) and Institute for Health Policy Management and Evaluation (Gomes), University of Toronto; MAP Centre for Urban Health Solutions (Gomes, Kolla), St. Michael's Hospital, Toronto, Ont.; Canadian Institute for Substance Use Research (Kolla), University of Victoria, Victoria, BC; London InterCommunity Health Centre (Sereda), London, Ont.; Department of Family and Community Medicine (Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.
CMAJ. 2022 Sep 19;194(36):E1233-E1242. doi: 10.1503/cmaj.220892.
London InterCommunity Health Centre (LIHC) launched a safer opioid supply (SOS) program in 2016, where clients are prescribed pharmaceutical opioids and provided with comprehensive health and social supports. We sought to evaluate the impact of this program on health services utilization and health care costs.
We conducted an interrupted time series analysis of London, Ontario, residents who received a diagnosis of opioid use disorder (OUD) and who entered the SOS program between January 2016 and March 2019, and a comparison group of individuals matched on demographic and clinical characteristics who were not exposed to the program. Primary outcomes were emergency department (ED) visits, hospital admissions, admissions for infections and health care costs. We used autoregressive integrated moving average (ARIMA) models to evaluate the impact of SOS initiation and compared outcome rates in the year before and after cohort entry.
In the time series analysis, rates of ED visits (-14 visits/100, 95% confidence interval [CI] -26 to -2; = 0.02), hospital admissions (-5 admissions/100, 95% CI -9 to -2; = 0.005) and health care costs not related to primary care or outpatient medications (-$922/person, 95% CI -$1577 to -$268; = 0.008) declined significantly after entry into the SOS program ( = 82), with no significant change in rates of infections (-1.6 infections/100, 95% CI -4.0 to 0.8; = 0.2). In the year after cohort entry, the rate of ED visits (rate ratio [RR] 0.69, 95% CI 0.53 to 0.90), hospital admissions (RR 0.46, 95% CI 0.29 to 0.74), admissions for incident infections (RR 0.51, 95% CI 0.27 to 0.96) and total health care costs not related to primary care or outpatient medications ($15 635 v. $7310/person-year; = 0.002) declined significantly among SOS clients compared with the year before. We observed no significant change in any of the primary outcomes among unexposed individuals ( = 303).
Although additional research is needed, this preliminary evidence indicates that SOS programs can play an important role in the expansion of treatment and harm-reduction options available to assist people who use drugs and who are at high risk of drug poisoning.
伦敦社区卫生中心于 2016 年推出了更安全的阿片类药物供应计划（SOS），为客户提供处方类阿片类药物，并提供全面的健康和社会支持。我们旨在评估该计划对卫生服务利用和医疗保健费用的影响。
我们对安大略省伦敦市接受阿片类药物使用障碍（OUD）诊断并于 2016 年 1 月至 2019 年 3 月期间进入 SOS 计划的患者以及未接触该计划的按人口统计学和临床特征匹配的对照组患者进行了中断时间序列分析。主要结局为急诊就诊、住院、感染住院和医疗保健费用。我们使用自回归综合移动平均（ARIMA）模型评估 SOS 启动的影响，并比较了队列进入前后的结果率。
在时间序列分析中，急诊就诊次数（-14 次/100，95%置信区间[CI]-26 至-2； = 0.02）、住院次数（-5 次/100，95%CI-9 至-2； = 0.005）和与初级保健或门诊药物无关的医疗保健费用（每人$922，95%CI-1577 至-268； = 0.008）显著下降SOS 计划进入后（ = 82），感染率无显著变化（-1.6 次/100，95%CI-4.0 至 0.8； = 0.2）。在队列进入后的一年中，急诊就诊率（相对风险[RR]0.69，95%CI0.53 至 0.90）、住院率（RR0.46，95%CI0.29 至 0.74）、因感染而住院的发生率（RR0.51，95%CI0.27 至 0.96）和与初级保健或门诊药物无关的总医疗保健费用（每人$15635 与$7310/人年； = 0.002）SOS 患者显著下降，而对照组患者无显著变化（ = 303）。我们未观察到未暴露个体的任何主要结局发生显著变化（ = 303）。
尽管还需要进一步研究，但这初步证据表明，SOS 计划可以在扩大治疗和减少吸毒者药物中毒风险的现有治疗和减少危害选择方面发挥重要作用。
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