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Drug Alcohol Depend. 2024 Jun 1;259:111290. doi: 10.1016/j.drugalcdep.2024.111290. Epub 2024 Apr 16.
We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018.
In this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009-2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined.
Overall, 94,491 clinicians prescribed buprenorphine dispensed during 2009-2018. The proportion of active prescribers meeting high-volume criteria increased from 7.4 % in 2009 to 16.7 % in 2018. High-volume prescribers accounted for 80 % of dispensed buprenorphine prescriptions during 2009-2018; very high-volume prescribers accounted for 26 %. Adult primary care physicians consistently comprised the majority of high-volume prescribers. Addiction specialists were much more likely to be high-volume prescribers compared to other specialties, including psychiatrists and pain specialists. By 2018, the proportion of prescriptions from high-volume prescribers paid by Medicaid had doubled to 40 %, accompanied by a decline in both self-pay and commercial insurance. High-volume prescribers were overwhelmingly concentrated in urban counties with the highest fatal overdose rates. In 2018, the highest density of high-volume prescribers was in New England and the mid-Atlantic region.
Growth in high-volume prescribers outpaced the overall growth in buprenorphine prescribers across 2009-2018. High-volume prescribers play an increasingly central role in providing medication for OUD in the U.S., yet results indicate key regional variation in the availability of high-volume buprenorphine prescribers.
我们研究了 2009 年至 2018 年间大剂量丁丙诺啡开方医生的数量和特征，以及他们丁丙诺啡开方的性质。
在这项观察性队列研究中，使用 IQVIA Real World 零售药房理赔数据来描述 2009-2018 年间高剂量丁丙诺啡开方医生（每月平均有 30 名或以上活跃患者的医生）的趋势。还检查了超高剂量处方（每月平均 100 名以上患者）。
总体而言，2009 年至 2018 年期间，有 94491 名医生开具丁丙诺啡处方。符合高剂量标准的活跃开方医生比例从 2009 年的 7.4%上升到 2018 年的 16.7%。高剂量开方医生在 2009 年至 2018 年期间开具了 80%的丁丙诺啡处方；超高剂量开方医生占 26%。成人初级保健医生一直是高剂量开方医生的主要群体。与精神病医生和疼痛专家等其他专业相比，成瘾专家更有可能成为高剂量开方医生。到 2018 年，由医疗补助支付的高剂量开方医生处方的比例增加了一倍，达到 40%，同时自付和商业保险的比例都有所下降。高剂量开方医生主要集中在城市县，这些县的致命过量死亡率最高。2018 年，高剂量开方医生密度最高的地区是新英格兰和大西洋中部地区。
2009 年至 2018 年间，高剂量开方医生的增长速度超过了丁丙诺啡开方医生的总体增长速度。高剂量开方医生在美国为治疗 OUD 提供药物的作用越来越重要，但结果表明，高剂量丁丙诺啡开方医生的供应在地区上存在明显差异。
