Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA.
School of Public Health, Oregon Health & Science University, 840 SW Gaines St, Portland, OR, 97239, USA.
J Gen Intern Med. 2023 Jun;38(8):1871-1876. doi: 10.1007/s11606-023-08027-4. Epub 2023 Jan 23.
For patients with opioid use disorder (OUD), medications for OUD (MOUD) reduce morbidity, mortality, and return to use. Nevertheless, a minority of patients receive MOUD, and underutilization is pronounced among rural patients.
While Veterans Health Administration (VHA) initiatives have improved MOUD access overall, it is unknown whether access has improved in rural VA health systems specifically. How "Community Care," healthcare paid for by VHA but received from non-VA providers, has affected rural access is also unknown.
Data for this observational study were drawn from the VHA Corporate Data Warehouse. Facility rurality was defined by rural-urban commuting area code of the primary medical center. International Classification of Diseases codes identified patients with OUD within each year, 2015-2020. We included MOUD (buprenorphine, methadone, extended-release naltrexone) received from VHA or paid for by VHA but received at non-VA facilities through Community Care. We calculated average yearly MOUD receipt; linear regression of outcomes on study years identified trends; an interaction between year and rural status evaluated trend differences over time.
All 129 VHA Health Systems, a designation that encompasses one or more medical centers and their affiliated community-based outpatient clinics MAIN MEASURES: The average proportion of patients diagnosed with OUD that receive MOUD within rural versus urban VHA health care systems.
From 2015 to 2020, MOUD access increased substantially: the average proportion of patients receiving MOUD increased from 34.6 to 48.9%, with a similar proportion of patients treated with MOUD in rural and urban systems in all years. Overall, a small proportion (1.8%) of MOUD was provided via Community Care, and Community Care did not disproportionately benefit rural health systems.
Strategies utilized by VHA could inform other health care systems seeking to ensure that, regardless of geographic location, all patients are able to access MOUD.
对于阿片类药物使用障碍（OUD）患者，OUD 药物治疗（MOUD）可降低发病率、死亡率和复吸率。然而，只有少数患者接受 MOUD，农村患者的使用率明显较低。
尽管退伍军人健康管理局（VHA）的举措总体上改善了 MOUD 的可及性，但具体而言，农村 VHA 卫生系统的 MOUD 可及性是否有所改善尚不清楚。VHA 支付但由非 VHA 提供者提供的“社区护理”如何影响农村地区的获得情况也尚不清楚。
本观察性研究的数据来自 VHA 公司数据仓库。设施的农村性通过主要医疗中心的城乡通勤区代码来定义。国际疾病分类代码在 2015 年至 2020 年的每一年中确定 OUD 患者。我们纳入了 VHA 提供或 VHA 支付但通过社区护理在非 VHA 设施接受的 MOUD（丁丙诺啡、美沙酮、纳曲酮延长释放剂）。我们计算了每年平均 MOUD 接受率；对结果进行线性回归以确定研究年份的趋势；在年与农村状况之间的交互作用评估了随时间的趋势差异。
所有 129 个 VHA 医疗系统，这一名称涵盖了一个或多个医疗中心及其附属的社区门诊诊所。
在农村与城市 VHA 医疗保健系统中，被诊断患有 OUD 的患者接受 MOUD 的平均比例。
从 2015 年到 2020 年，MOUD 的可及性大幅增加：接受 MOUD 治疗的患者比例从 34.6%增加到 48.9%，所有年份农村和城市系统中接受 MOUD 治疗的患者比例相似。总体而言，通过社区护理提供的 MOUD 比例很小（1.8%），并且社区护理并没有不成比例地使农村卫生系统受益。
VHA 采用的策略可以为其他寻求确保无论地理位置如何，所有患者都能够获得 MOUD 的医疗保健系统提供信息。
