Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA.
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street MS 035, Waltham, MA 02453, USA.
Drug Alcohol Depend. 2024 Mar 1;256:111125. doi: 10.1016/j.drugalcdep.2024.111125. Epub 2024 Feb 14.
Opioid use disorder (OUD) is a leading cause of preventable death and injury nationwide. Efforts to increase the use of medication for opioid use disorder (MOUD) are needed. In 2017, Washington State implemented a Hub and Spoke (HS) model of care with the primary goal of expanding access to MOUD. We examined changes in MOUD utilization among Washington State Medicaid beneficiaries before and after HS implementation.
We used Medicaid claims data to examine longitudinal changes in MOUD use for beneficiaries with OUD. We conducted a comparative interrupted time series analysis to examine the association between HS policy implementation and rates of MOUD utilization, overall and by type of medication.
Between 2016 and 2019, a period of increasing OUD prevalence, rates of MOUD utilization among Washington Medicaid beneficiaries increased overall from 39.7 to 50.5. Following HS implementation, rates of MOUD use grew at a significantly greater rate in the HS cohort than in the non-HS cohort (β=0.54, SE=0.02, p< 0.0001, 95% CI 0.49, 0.59). Analyses by medication type show that this rate increase was primarily due to buprenorphine use (β= 0.61, SE= 0.02, p< 0.0001, 95% CI 0.57, 0.65).
Improved systems of care are needed to make MOUD accessible to all patients in need. The Washington HS model is one strategy that may facilitate and expand MOUD use, particularly buprenorphine. Over the study period, Washington State saw increased use of buprenorphine, which was an emphasis of their HS model.
阿片类药物使用障碍（OUD）是全美可预防死亡和伤害的主要原因。需要努力增加阿片类药物使用障碍（MOUD）的使用。2017 年，华盛顿州实施了枢纽和辐条（HS）护理模式，主要目标是扩大 MOUD 的获取途径。我们检查了 HS 实施前后华盛顿州医疗补助受益人的 MOUD 利用率变化。
我们使用医疗补助数据来检查患有 OUD 的受益人的 MOUD 使用的纵向变化。我们进行了比较性中断时间序列分析，以检查 HS 政策实施与 MOUD 利用率（总体和按药物类型）之间的关联。
在 2016 年至 2019 年期间，OUD 患病率增加，华盛顿州医疗补助受益人的 MOUD 利用率总体从 39.7%增加到 50.5%。在 HS 实施后，HS 队列中的 MOUD 使用增长率明显高于非 HS 队列（β=0.54，SE=0.02，p<0.0001，95%CI 0.49，0.59）。按药物类型分析表明，这种增长率的增加主要是由于丁丙诺啡的使用（β=0.61，SE=0.02，p<0.0001，95%CI 0.57，0.65）。
需要改进护理系统，使所有有需要的患者都能获得 MOUD。华盛顿州的 HS 模式是一种可能促进和扩大 MOUD 使用的策略，特别是丁丙诺啡。在研究期间，华盛顿州看到了丁丙诺啡使用的增加，这是其 HS 模式的重点。
