Calhoun Stacy, Guo Huiying, Fei Zhe, Lin Chunqing, Clingan Sarah E, Zhu Yuhui, Mooney Larissa J, Hser Yih-Ing
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
Department of Statistics, University California, Riverside, CA, USA.
Drug Alcohol Depend Rep. 2024 Aug 23;12:100276. doi: 10.1016/j.dadr.2024.100276. eCollection 2024 Sep.
There is limited research examining factors impacting MOUD retention in rural settings, especially within the context of the COVID-19 pandemic. Using electronic health records data collected as part of a NIDA Clinical Trials Network study (CTN-0102), this study explored how the onset of the COVID-19 pandemic may have impacted MOUD retention in a sample of 563 rural primary care patients.
Cox regression model was applied to examine if COVID-19 was related to treatment retention, controlling for demographics, clinic, insurance type, and other diagnoses. The independent variable was the number of days between the patient's first MOUD prescription date during the pre-COVID observation period (10/1/2019-3/13/2020) and the start of the COVID-19 pandemic. The dependent variable was retention on MOUD, defined as the time from the first MOUD prescription documented during the pre-COVID observation period to the first break in consecutive MOUD prescriptions (right censored at 180 days).
The findings demonstrated that there was a reduced risk of a prescription break for every 10-day increase in the time from the first documented MOUD prescription to the onset of the COVID-19 pandemic (HR = 0.96, 95 % CI = 0.92-0.99; = 0.011).
While the data did not include complete treatment histories to determine who was new to MOUD treatment, the findings suggest that patients whose first documented MOUD prescription in the dataset was closer to the onset of the pandemic had a greater likelihood of experiencing retention challenges. This underscores the importance for clinics to establish comprehensive contingency plans for future emergencies to ensure uninterrupted MOUD treatment and support, particularly for individuals in the early stabilization phase of their recovery.
关于影响农村地区药物辅助治疗（MOUD）留存率的因素的研究有限，尤其是在新冠疫情背景下。本研究利用作为美国国立药物滥用研究所临床试验网络研究（CTN - 0102）一部分收集的电子健康记录数据，探讨了新冠疫情的爆发如何影响563名农村初级保健患者样本中的MOUD留存率。
应用Cox回归模型来检验新冠疫情是否与治疗留存率相关，并对人口统计学、诊所、保险类型和其他诊断进行控制。自变量是患者在新冠疫情前观察期（2019年10月1日至2020年3月13日）首次开具MOUD处方日期与新冠疫情开始之间的天数。因变量是MOUD留存率，定义为从新冠疫情前观察期记录的首次MOUD处方到连续MOUD处方首次中断的时间（在180天处右删失）。
研究结果表明，从首次记录的MOUD处方到新冠疫情爆发的时间每增加10天，处方中断的风险就会降低（风险比[HR] = 0.96，95%置信区间[CI] = 0.92 - 0.99；P = 0.011）。
虽然数据不包括完整的治疗史以确定谁是MOUD治疗的新患者，但研究结果表明，数据集中首次记录的MOUD处方更接近疫情爆发的患者面临留存挑战的可能性更大。这凸显了诊所为未来紧急情况制定全面应急计划的重要性，以确保MOUD治疗和支持的不间断，特别是对于处于康复早期稳定阶段的个体。
