Burke Ashley, Vadiei Nina, Mollon Lea
Banner - University Medical Center South, 2800 Ajo Way, Tucson, AZ 85713, United States.
The University of Texas at Austin, College of Pharmacy, Division of Pharmacotherapy, 8403 Floyd Curl Dr, Austin, TX 78229, United States.
Drug Alcohol Depend Rep. 2024 Nov 8;13:100292. doi: 10.1016/j.dadr.2024.100292. eCollection 2024 Dec.
There are many barriers to prescribing medications for opioid use disorder (MOUD). This study evaluates the prevalence, patterns, and predictors of inpatient MOUD prescribing at discharge to patients with a diagnosis of opioid use/opioid use disorder (OUD) that developed opioid withdrawal during their hospital stay.
This multicenter, retrospective cross-sectional study occurred at three hospitals in Arizona. Patients who developed opioid withdrawal during their hospitalization and had a documented opioid-related disorder between January 1, 2021, and January 1, 2022, were included in the study. Patient-specific factors were evaluated as predictors of MOUD prescribing at hospital discharge using descriptive, multivariate regression.
A total of 382 encounters were included; 249 had documented OUD (65.2 %), 75 of which were discharged with MOUD (75/249; 30.1 %). Patients with moderate/moderately severe opioid withdrawal had higher odds of being discharged with MOUD compared to those with mild opioid withdrawal (OR 2.87 [1.44-5.69], p=0.003). Patients admitted to the largest hospital in Phoenix had higher odds of being prescribed MOUD compared to the largest hospital in Tucson (OR 8.23 [3.02-22.49], p<0.001), as were patients who underwent a routine discharge compared to patient directed discharges (7.63 [2.35-24.71], p=0.001).
Less than one-third of patients with OUD that developed opioid withdrawal during their hospitalization were prescribed MOUD at discharge. Treatment facility, opioid withdrawal severity, and discharge disposition were predictors of MOUD prescribing. Inpatient health-systems and policymakers may consider these data when developing policies/procedures aimed at increasing MOUD prescribing rates.
开具用于阿片类物质使用障碍（MOUD）的药物存在诸多障碍。本研究评估了出院时为住院期间出现阿片类物质戒断症状且诊断为阿片类物质使用/阿片类物质使用障碍（OUD）的患者开具MOUD药物的患病率、模式及预测因素。
这项多中心回顾性横断面研究在亚利桑那州的三家医院开展。纳入2021年1月1日至2022年1月1日期间住院期间出现阿片类物质戒断症状且有阿片类物质相关障碍记录的患者。采用描述性、多变量回归分析评估患者个体因素作为出院时开具MOUD药物的预测因素。
共纳入382次诊疗；249例有记录的OUD（65.2%），其中75例出院时开具了MOUD药物（75/249；30.1%）。与轻度阿片类物质戒断患者相比，中度/中度严重阿片类物质戒断患者出院时开具MOUD药物的几率更高（比值比2.87 [1.44 - 5.69]，p = 0.003）。与图森市最大的医院相比，入住凤凰城最大医院的患者开具MOUD药物的几率更高（比值比8.23 [3.02 - 22.49]，p < 0.001），与患者自行出院相比，常规出院的患者也是如此（7.63 [2.35 - 24.71]，p = 0.001）。
住院期间出现阿片类物质戒断症状的OUD患者中，不到三分之一在出院时开具了MOUD药物。治疗机构、阿片类物质戒断严重程度和出院处置方式是开具MOUD药物的预测因素。住院医疗系统和政策制定者在制定旨在提高MOUD药物开具率的政策/程序时可考虑这些数据。
