仅通过远程医疗治疗阿片类药物使用障碍时的丁丙诺啡停药：一项纵向队列分析。
Buprenorphine discontinuation in telehealth-only treatment for opioid use disorder: A longitudinal cohort analysis.
机构信息
Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America; Central City Concern, Portland, OR, United States of America.
Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, United States of America.
出版信息
J Subst Use Addict Treat. 2024 Dec;167:209511. doi: 10.1016/j.josat.2024.209511. Epub 2024 Sep 5.
INTRODUCTION
At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes.
METHODS
A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington. The intervention was a fully telehealth-only (THO) app versus treatment as usual (TAU) in office-based settings with some telehealth. We assessed self-reported buprenorphine discontinuation at 4-,12-, and 24-weeks. Generalized estimating equations (GEE) calculated unadjusted and adjusted relative risk ratios (RR) for discontinuation averaged over the study period. Secondary outcomes included change in the Brief Addiction Monitor (BAM) and the visual analogue craving scale. Generalized linear models estimated average within-group and between-group differences over time.
RESULTS
Participants (n = 103 THO; n = 56 TAU) had a mean age of 37 years (SD = 9.8 years) and included 52 % women, 83 % with Medicaid insurance, 80 % identified as White, 65 % unemployed/student, and 19 % unhoused. There were differences in gender (THO = 54 % women vs. TAU = 44 %, p = .04), unemployed status (60 % vs 75 %, p = .02), and stable housing (84 % vs 73 %, p = .02). Rates of buprenorphine discontinuation were low in the THO (4 %) and TAU (13 %) groups across 24 weeks. In the adjusted analysis, the risk of discontinuation was 61 % lower in the THO group (aRR = 0.39, 95 % CI [0.17, 0.89], p = .026). Decreases occurred over time on the harms subscale of the BAM (within-group difference - 0.85, p = .0004 [THO], and - 0.68, p = .04 [TAU]) and cravings (within-group difference - 13.47, p = .0001 [THO] vs -7.65, p = .01 [TAU]).
CONCLUSIONS
A telehealth-only platform reduced the risk of buprenorphine discontinuation compared to office-based TAU. In-person evaluation to receive buprenorphine may not be necessary for treatment-seeking patients.
CLINICAL TRIALS IDENTIFIER
NCT03224858.
简介
在 COVID-19 大流行初期，联邦机构允许通过远程医疗启动丁丙诺啡治疗阿片类药物使用障碍（OUD），而无需进行面对面评估。目前尚不清楚仅通过远程医疗进行丁丙诺啡治疗如何影响停药时间和患者报告的治疗结果。
方法
一项纵向观察性队列研究于 2021 年 9 月至 2023 年 3 月在俄勒冈州和华盛顿州进行，招募了互联网和电话接入的 OUD 患者，他们在 45 天内开始使用丁丙诺啡。干预措施是完全通过远程医疗（THO）应用程序与办公室环境下的常规治疗（TAU）进行比较，后者允许一些远程医疗。我们评估了在 4 周、12 周和 24 周时自我报告的丁丙诺啡停药情况。广义估计方程（GEE）计算了研究期间平均停药的未经调整和调整后的相对风险比（RR）。次要结局包括Brief Addiction Monitor（BAM）和视觉模拟渴望量表的变化。广义线性模型估计了随时间的平均组内和组间差异。
结果
参与者（n=103 例 THO；n=56 例 TAU）的平均年龄为 37 岁（标准差=9.8 岁），其中 52%为女性，83%有医疗补助保险，80%为白人，65%失业/学生，19%无家可归。两组在性别（THO=54%女性 vs. TAU=44%，p=0.04）、失业状况（60% vs 75%，p=0.02）和稳定住房（84% vs 73%，p=0.02）方面存在差异。在 24 周的时间里，THO（4%）和 TAU（13%）组的丁丙诺啡停药率均较低。在调整分析中，THO 组的停药风险降低了 61%（调整后的相对风险=0.39，95%置信区间[0.17, 0.89]，p=0.026）。BAM 的危害子量表得分随时间下降（组内差异-0.85，p=0.0004[THO]和-0.68，p=0.04[TAU]）和渴望（组内差异-13.47，p=0.0001[THO]与-7.65，p=0.01[TAU]）。
结论
与基于办公室的 TAU 相比，仅通过远程医疗平台降低了丁丙诺啡停药的风险。对于寻求治疗的患者，可能不需要进行面对面评估即可获得丁丙诺啡。
临床试验标识符
NCT03224858。
Zotero 插件