Beygui Nooshin C, Duross Erin, Cheng Chin-I, Mesaros Katherine, Gawronski Karissa, Perzhinsky Juliette
Central Michigan University College of Medicine, Mt. Pleasant, MI, USA.
Central Michigan University College of Science and Technology, Mt. Pleasant, MI, USA.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251331322. doi: 10.1177/21501319251331322. Epub 2025 Apr 2.
The increasing prevalence of opioid use coupled with the emergence of the Coronavirus Disease-19 (COVID-19) pandemic impacted opioid overdoses and death rates. People with opioid use disorder (OUD) are particularly vulnerable to the pandemic's consequences. Although Medications for Opioid Use Disorder (MOUD) are the most well supported treatment for OUD, they remain underutilized by clinicians, particularly in the primary care setting, emphasizing the importance of examining factors that impact prescribing.
To assess clinicians' prescribing practices for MOUD and assess the pandemic's effect on MOUD prescription. To determine whether there is an association between patient-specific factors, such as mental health diagnoses and substance use disorder (SUD), and MOUD prescription practices prior to and during the COVID-19 pandemic.
A retrospective chart review assessed 500 patient charts with a diagnosis of OUD to assess demographics, MOUD prescribing, substance use, and co-morbid mental health conditions.
312 charts met inclusion criteria. There was no significant difference in the percentage of new MOUD prescriptions among the selected cohort between the 2 selected timeframes, nor was there a significant difference in the prescriber/setting of new prescriptions. Cumulative analysis revealed that greater than 2/3 of the selected patients had concurrent mental health diagnoses. Greater than 50% of patients reported active non-opioid substance use. The odds of having a co-occurring SUD were significantly higher among patients treated in the emergency department and various treatment settings-including urgent care and non-primary care clinics-as compared to the primary care outpatient setting.
Strong evidence supports the efficacy of using MOUD in primary care, yet it is underutilized in the mid-Michigan region. Overall prevalence of mental health diagnoses, SUD, MOUD prescriber practices were similar prior to and during the COVID-19 pandemic. There was a high occurrence of co-occurring SUD especially among patients treated outside of the primary care setting. Future initiatives to increase clinician education around MOUD and address patient barriers to treatment are warranted.
阿片类药物使用的日益普遍，再加上冠状病毒病2019（COVID - 19）大流行的出现，影响了阿片类药物过量使用和死亡率。患有阿片类药物使用障碍（OUD）的人尤其容易受到大流行后果的影响。尽管阿片类药物使用障碍药物（MOUD）是治疗OUD最有充分依据的方法，但临床医生对其使用仍然不足，尤其是在初级保健环境中，这凸显了研究影响处方因素的重要性。
评估临床医生对MOUD的处方做法，并评估大流行对MOUD处方的影响。确定患者特定因素，如心理健康诊断和物质使用障碍（SUD），与COVID - 19大流行之前和期间的MOUD处方做法之间是否存在关联。
一项回顾性病历审查评估了500例诊断为OUD的患者病历，以评估人口统计学、MOUD处方、物质使用和共病心理健康状况。
312份病历符合纳入标准。在两个选定的时间段内，选定队列中新MOUD处方的百分比没有显著差异，新处方的开处方者/环境也没有显著差异。累积分析显示，超过三分之二的选定患者有并发心理健康诊断。超过50%的患者报告有活跃的非阿片类物质使用。与初级保健门诊环境相比，在急诊科和各种治疗环境（包括紧急护理和非初级保健诊所）接受治疗的患者中，同时发生SUD的几率显著更高。
有力证据支持在初级保健中使用MOUD的有效性，但在密歇根州中部地区其使用不足。在COVID - 19大流行之前和期间，心理健康诊断、SUD的总体患病率以及MOUD开处方者的做法相似。同时发生SUD的情况很常见，尤其是在初级保健环境之外接受治疗的患者中。有必要开展未来的举措，以加强临床医生对MOUD的教育，并解决患者的治疗障碍。
