Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024, United States of America.
Department of Family Medicine, University of Washington, Seattle, WA 98195, United States of America.
J Subst Use Addict Treat. 2024 Mar;158:209269. doi: 10.1016/j.josat.2023.209269. Epub 2023 Dec 12.
Co-occurring substance use disorders (SUDs) among individuals with opioid use disorder (OUD) are associated with additional impairment, overdose, and death. This study examined characteristics of patients who have OUD with and without co-occurring SUDs in rural primary care clinics.
Secondary analysis used electronic health record (EHR) data from six rural primary care clinics, including demographics, diagnoses, encounters, and prescriptions of medication for OUD (MOUD), as well as EHR data from an external telemedicine vendor that provided MOUD to some clinic patients. The study population included all adult patients who had a visit to the participating clinics from October 2019 to January 2021.
We identified 1164 patients with OUD; 72.6 % had OUD only, 11.5 % had OUD and stimulant use disorder (OUD + StUD), and 15.9 % had OUD and other non-stimulant substance use disorder (OUD + Other). The OUD + StUD group had the highest rates of hepatitis C virus (25.4 % for OUD + StUD, 17.8 % for OUD + Other, and 7.5 % for OUD Only; p < 0.001) and the highest rates of mental health disorders (78.4 %, 69.7 %, and 59.9 %, respectively; p < 0.001). Compared to the OUD Only group, patients in the OUD + StUD and OUD + Other groups were more likely to receive telehealth services provided by clinic staff, in-clinic behavioral health services, and in-clinic MOUD. The OUD + StUD group had the highest proportion of referrals to the external telemedicine vendor.
More than 27 % of patients with OUD in rural primary care clinics had other co-occurring SUDs, and these patients received more healthcare services than those with OUD only. Future studies should examine variations in outcomes associated with these other services among patients with OUD and co-occurring SUDs.
阿片类药物使用障碍（OUD）患者同时存在物质使用障碍（SUD）会导致更多的损伤、过量用药和死亡。本研究在农村初级保健诊所中，检查了患有 OUD 且伴有和不伴有共病 SUD 的患者的特征。
使用来自六个农村初级保健诊所的电子健康记录（EHR）数据进行二次分析，包括人口统计学、诊断、就诊情况以及阿片类药物使用障碍（OUD）的药物治疗（MOUD）处方，以及来自外部远程医疗供应商的 EHR 数据，该供应商为一些诊所患者提供 MOUD。研究人群包括自 2019 年 10 月至 2021 年 1 月期间到参与诊所就诊的所有成年患者。
我们确定了 1164 名患有 OUD 的患者；72.6%的患者仅患有 OUD，11.5%的患者同时患有 OUD 和兴奋剂使用障碍（OUD+StUD），15.9%的患者同时患有 OUD 和其他非兴奋剂物质使用障碍（OUD+Other）。OUD+StUD 组丙型肝炎病毒（HCV）的发生率最高（OUD+StUD 组为 25.4%，OUD+Other 组为 17.8%，OUD 组仅为 7.5%；p<0.001），且精神健康障碍的发生率最高（分别为 78.4%、69.7%和 59.9%；p<0.001）。与 OUD 组相比，OUD+StUD 和 OUD+Other 组的患者更有可能接受诊所工作人员提供的远程医疗服务、诊所内的行为健康服务和诊所内的 MOUD。OUD+StUD 组向外部远程医疗供应商转诊的比例最高。
在农村初级保健诊所中，超过 27%的 OUD 患者存在其他共病 SUD，这些患者比仅患有 OUD 的患者接受了更多的医疗服务。未来的研究应检查 OUD 患者和共病 SUD 患者在这些其他服务相关结局方面的差异。
