Department of Psychiatry, Columbia University Medical Center, New York, NY.
Ophelia Health Inc., New York, NY.
Am J Drug Alcohol Abuse. 2023 Mar 4;49(2):260-265. doi: 10.1080/00952990.2023.2180382. Epub 2023 Mar 24.
Despite lifesaving medications such as buprenorphine and methadone, the majority of individuals with opioid use disorder (OUD) face access barriers to evidence-based treatment. COVID-19 era regulatory reforms have shown that telehealth can improve access to care, although disparities in clinical outcomes are likely to persist. We aimed to analyze 180-day and 365-day retention in treatment with buprenorphine for OUD overall and by demographics, hypothesizing that retention would be lower among racial/ethnic minorities and rural patients. We analyzed data from a cohort of individuals with OUD enrolled in treatment from April 1, 2020 to September 30, 2021, in Pennsylvania and New York using a virtual-first telehealth OUD treatment platform to assess rates of 180-day and 365-day retention. Associations between demographic characteristics and retention were assessed using unadjusted and adjusted logistic regression models. Among 1,378 patients (58.8% male), 180-day retention was 56.4%, and 365-day retention was 48.3%. Adjusted analyses found that only an association between older age and greater odds of 180-day retention was significant (aOR for patients aged 30-50 vs. <30: 1.83 [1.37-2.45]). There were no significant associations between sex, race/ethnicity, state, or rurality with retention. While we were unable to control for socioeconomic variables, we found retention within telehealth services for buprenorphine was high irrespective of geography or race/ethnicity, but disparities with age indicate a subset of patients who may benefit from more intensive services early in care.
尽管有丁丙诺啡和美沙酮等救命药物，但大多数阿片类药物使用障碍（OUD）患者在获得基于证据的治疗方面面临障碍。COVID-19 时代的监管改革表明，远程医疗可以改善获得护理的机会，尽管临床结果的差异可能仍然存在。我们旨在分析总体和按人口统计学因素（假设保留率在种族/少数民族和农村患者中较低）使用丁丙诺啡治疗 OUD 的 180 天和 365 天保留率。我们使用虚拟优先远程医疗 OUD 治疗平台分析了 2020 年 4 月 1 日至 2021 年 9 月 30 日期间在宾夕法尼亚州和纽约州接受治疗的 OUD 患者队列的数据，以评估 180 天和 365 天保留率。使用未调整和调整后的逻辑回归模型评估人口统计学特征与保留之间的关联。在 1378 名患者（58.8%为男性）中，180 天保留率为 56.4%，365 天保留率为 48.3%。调整后的分析发现，仅年龄较大与 180 天保留的几率较高之间存在关联（年龄在 30-50 岁与<30 岁的患者相比：1.83 [1.37-2.45]）。性别、种族/族裔、州或农村地区与保留率之间没有显著关联。虽然我们无法控制社会经济变量，但我们发现远程医疗服务中丁丙诺啡的保留率很高，无论地理位置或种族/族裔如何，但与年龄相关的差异表明，在护理早期，有一部分患者可能受益于更密集的服务。
