Bobb Jennifer F, Idu Abisola E, Qiu Hongxiang, Yu Onchee, Boudreau Denise M, Wartko Paige D, Matthews Abigail G, McCormack Jennifer, Lee Amy K, Campbell Cynthia I, Saxon Andrew J, Liu David S, Altschuler Andrea, Samet Jeffrey H, Northrup Thomas F, Braciszewski Jordan M, Murphy Mark T, Arnsten Julia H, Cunningham Chinazo O, Horigian Viviana E, Szapocznik José, Glass Joseph E, Caldeiro Ryan M, Tsui Judith I, Burganowski Rachael P, Weinstein Zoe M, Murphy Sean M, Hyun Noorie, Bradley Katharine A
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA.
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA.
Drug Alcohol Depend. 2024 Aug 1;261:111350. doi: 10.1016/j.drugalcdep.2024.111350. Epub 2024 Jun 10.
Patients with opioid use disorder (OUD) have increased emergency and hospital utilization. The PROUD trial showed that implementation of office-based addiction treatment (OBAT) increased OUD medication treatment compared to usual care, but did not decrease acute care utilization in patients with OUD documented pre-randomization (clinicaltrials.gov/study/NCT03407638). This paper reports secondary emergency and hospital utilization outcomes in patients with documented OUD in the PROUD trial.
This cluster-randomized implementation trial was conducted in 12 clinics from 6 diverse health systems (March 2015-February 2020). Patients who visited trial clinics and had an OUD diagnosis within 3 years pre-randomization were included in primary analyses; secondary analyses added patients with OUD who were new to the clinic or with newly-documented OUD post-randomization. Outcomes included days of emergency care and hospital utilization over 2 years post-randomization. Explanatory outcomes included measures of OUD treatment. Patient-level analyses used mixed-effect regression with clinic-specific random intercepts.
Among 1988 patients with documented OUD seen pre-randomization (mean age 49, 53 % female), days of emergency care or hospitalization did not differ between intervention and usual care; OUD treatment also did not differ. In secondary analyses among 1347 patients with OUD post-randomization, there remained no difference in emergency or hospital utilization despite intervention patients receiving 32.2 (95 % CI 4.7, 59.7) more days of OUD treatment relative to usual care.
Implementation of OBAT did not reduce emergency or hospital utilization among patients with OUD, even in the sample with OUD first documented post-randomization in whom the intervention increased treatment.
阿片类物质使用障碍（OUD）患者的急诊和住院使用率有所增加。PROUD试验表明，与常规治疗相比，实施基于办公室的成瘾治疗（OBAT）增加了OUD药物治疗，但并未降低随机分组前有记录的OUD患者的急性护理使用率（clinicaltrials.gov/study/NCT03407638）。本文报告了PROUD试验中有记录的OUD患者的二级急诊和住院使用结果。
这项整群随机实施试验在来自6个不同卫生系统的12家诊所进行（2015年3月至2020年2月）。在随机分组前3年内就诊于试验诊所且被诊断为OUD的患者纳入主要分析；二级分析纳入了诊所新诊断为OUD的患者或随机分组后新记录为OUD的患者。结局包括随机分组后2年内的急诊护理天数和住院使用率。解释性结局包括OUD治疗的指标。患者层面的分析采用具有特定诊所随机截距的混合效应回归。
在随机分组前就诊的1988例有记录的OUD患者中（平均年龄49岁，53%为女性），干预组和常规治疗组的急诊护理天数或住院天数无差异；OUD治疗也无差异。在随机分组后有OUD的1347例患者的二级分析中，尽管干预组患者相对于常规治疗组接受了多32.2天（95%CI 4.7，59.7）的OUD治疗，但急诊或住院使用率仍无差异。
实施OBAT并未降低OUD患者的急诊或住院使用率，即使在随机分组后首次记录为OUD且干预增加了治疗的样本中也是如此。
