Department of Biostatistics, University of Michigan, Ann Arbor.
Department of Anesthesiology, University of Michigan, Ann Arbor.
JAMA Netw Open. 2023 Dec 1;6(12):e2349103. doi: 10.1001/jamanetworkopen.2023.49103.
Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown.
To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023.
MOC engagement.
County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population).
Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before.
In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
丁丙诺啡是一种在治疗阿片类药物使用障碍（OUD）方面使用不足的药物，可以在一般医疗环境中开处方。密歇根州阿片类药物合作组织（MOC）成立于 2017 年，是一个外联和教育项目，旨在解决临床医生和社区在获得丁丙诺啡方面的障碍；然而，MOC 与丁丙诺啡治疗之间的关系尚不清楚。
评估 MOC 服务使用与县一级丁丙诺啡处方密度和接受丁丙诺啡治疗的患者人数的时间趋势之间的关联。
设计、地点和参与者：本队列研究利用 MOC 服务在密歇根州所有县的交错实施。通过对所有县应用线性固定效应回归，进行差异中的差异分析，以估计 MOC 参与与结果的总体关联，并对每个 MOC 参与的县进行线性回归，以使用 2015 年 5 月至 2020 年 8 月的数据推断县特定的结果。分析于 2021 年 9 月至 2023 年 11 月进行。
MOC 参与。
县一级每月丁丙诺啡处方人数和接受丁丙诺啡治疗的患者人数（每 10 万人）。
在 83 个总县中，密歇根州有 57 个县（68.7%）通过 MOC 参与，其中 3 个县（3.6%）于 2017 年开始参与，19 个县（22.9%）于 2018 年，27 个县（32.5%）于 2019 年，8 个县（9.6%）于 2020 年。密歇根州由 83 个县组成，总人口为 999 万人。共有 507 万人（50.8%）为女性，141 万人（14.1%）为非裔美国人或黑人，53 万人（5.3%）为西班牙裔或拉丁裔，747 万人（74.7%）为非西班牙裔白人。各县中位数年龄的平均值（SD）为 44.8（6.4）。在参与前（包括非参与县的所有时间点）和参与后期间，丁丙诺啡处方人数的每月增长分别为 0.07 和 0.39 每 100000 人，绝对值为 0.33（95%CI，0.12-0.53）每 100000 人（P =.002）。接受丁丙诺啡治疗的患者人数每月平均分别增加 0.6 和 7.15，参与前和参与后期间分别为每 100000 人，这表明与参与前相比，每月增加了 6.56（95%CI，2.09-11.02）每 100000 人接受丁丙诺啡治疗（P =.004）。
在这项测量密歇根州随时间推移的丁丙诺啡处方的队列研究中，县一级参与由多学科团队提供的阿片类药物使用障碍重点外联和临床医生教育服务与丁丙诺啡处方者和接受丁丙诺啡治疗的患者人数的时间增加有关。
