Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Contraception. 2023 Jan;117:67-72. doi: 10.1016/j.contraception.2022.09.129. Epub 2022 Oct 12.
OBJECTIVE(S): To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women.
IBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the (1) crude prevalence, and (2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for ≥6 years. Claims data was used to define contraception use. Fisher exact test or χ test with a P-value ≤ 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively.
Only 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06-1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method.
Among women with ≥ 6 years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care.
Only two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD.
了解在商业保险和医疗补助保险的女性中，与开处阿片类药物使用障碍（MOUD）药物相比，使用避孕方法的情况在处方和未处方 MOUD 的女性中存在何种差异。
使用 IBM Watson Health MarketScan 商业索赔和就诊数据库和多州医疗补助数据库，计算 2018 年在年龄 20 至 49 岁、有连续商业保险或医疗补助保险覆盖至少 6 年的 OUD 女性中，按 MOUD 状态（有 MOUD 与无 MOUD），分别计算使用长效可逆或短效激素避孕方法或女性绝育与不使用任何避孕方法（无方法）的（1）粗患病率，以及（2）调整后的比值比（按人口统计学特征调整）。使用索赔数据来定义避孕方法的使用情况。Fisher 确切检验或 χ 检验（基于 Holm-Bonferroni 方法，P 值≤0.0001），95%置信区间用于分别确定患病率估计值和调整后的比值比的统计学显著差异。
仅有 41%的有 OUD 的商业保险和医疗补助保险女性被处方 MOUD。有 MOUD 的 Medicaid 保险的 OUD 女性使用无方法的粗患病率明显较低（71.1%比 79.0%），而使用女性绝育的可能性较高（调整后的比值比，1.33；95%置信区间：1.06-1.67 比无方法），比未处方 MOUD 的女性高。在商业保险的女性中，MOUD 状态与避孕方法之间没有差异，有 66%的女性未使用任何方法。
在有≥6 年连续保险覆盖的女性中，避孕方法的使用因 MOUD 状态和保险而异。为 OUD 女性开具 MOUD 处方可以得到改善，以确保提供高质量的护理。
仅有五分之二的 OUD 女性有被处方 MOUD 的证据，而且大多数女性未使用处方避孕药或女性绝育。我们的研究结果支持改善 MOUD 处方的机会，并整合避孕和 MOUD 服务，以改善 OUD 女性的临床护理。
