Ware Orrin D, Lister Jamey J, Cooper Sarah E, Kim Andrew H, Lister Holly H, Peterson N Andrew, Fioravanti Stephen, Powell Kristen Gilmore, Marcello Stephanie C, Joseph Bethany
School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
Addict Sci Clin Pract. 2025 May 8;20(1):39. doi: 10.1186/s13722-025-00564-z.
Opioid use disorder often co-occurs with other mental health and substance use disorders. Identifying clusters of individuals receiving treatment for opioid use disorder based on co-diagnosed conditions, healthcare plans, and service utilization over a seven-year treatment period provides insight into service needs. Objectives included [1] characterizing the sample [2], examining subtypes of the sample using cluster analysis, and [3] identifying differences in Current Procedural Terminology by subtype to examine service utilization among identified clusters.
This study uses secondary data from the electronic medical records of a community health center in a large urban area in the Northeastern United States from 2015 to 2021. The study sample included N = 705 adults who had an opioid use disorder diagnosis as indicated by the community health center's electronic medical records. Measures include [1] age [2], race and ethnicity [3], sex [4], healthcare plan(s) [5], co-occurring mental health disorder [6], co-occurring substance use disorder [7], co-occurring mental health disorder or substance use disorder, and [8] Current Procedural Terminology codes for behavioral health service utilization. Cluster analysis was used to examine the sample. These clusters were then analyzed for service utilization with a one-way analysis of variance.
The cluster analysis identified six clusters with an average silhouette of 0.5, indicating good clustering. These six clusters were operationalized as [1] Medicare/Medicaid healthcare plan with substance use disorder needs [2], Private pay and charity care healthcare plan with cocaine use disorder needs [3], Medicare/Medicaid and other publicly-funded healthcare plans with mood disorder needs [4], Private healthcare plan with low co-occurring disorder needs [5], Other publicly-funded healthcare plan with cannabis use disorder needs [6], Medicare/Medicaid healthcare plan with mental health disorder needs. Service utilization differed between these clusters with cluster mean differences for psychotherapy sessions (F = 8.55, p < 0.001), psychiatric sessions (F = 22.72, p < 0.001), and group therapy sessions (F = 10.76, p < 0.001).
This study highlights the importance of comprehensive and integrated treatment for substance use disorders and mental health disorders, particularly for those in underserved communities. Healthcare coverage, a socioeconomic factor that impacts access to care, is critical in distinguishing treatment needs and utilization.
阿片类物质使用障碍常与其他心理健康和物质使用障碍同时出现。基于共诊断情况、医疗保健计划以及七年治疗期内的服务利用情况，识别接受阿片类物质使用障碍治疗的个体集群，有助于深入了解服务需求。目标包括：[1]描述样本特征；[2]使用聚类分析检查样本的亚型；[3]按亚型识别当前程序术语的差异，以检查已识别集群中的服务利用情况。
本研究使用了美国东北部一个大城市社区卫生中心2015年至2021年电子病历中的二手数据。研究样本包括社区卫生中心电子病历显示患有阿片类物质使用障碍诊断的N = 705名成年人。测量指标包括：[1]年龄；[2]种族和族裔；[3]性别；[4]医疗保健计划；[5]共病的心理健康障碍；[6]共病的物质使用障碍；[7]共病的心理健康障碍或物质使用障碍；[8]行为健康服务利用的当前程序术语代码。使用聚类分析检查样本。然后用单因素方差分析对这些集群的服务利用情况进行分析。
聚类分析识别出六个集群，平均轮廓系数为0.5，表明聚类效果良好。这六个集群分别为：[1]有物质使用障碍需求的医疗保险/医疗补助医疗保健计划；[2]有可卡因使用障碍需求的自费和慈善护理医疗保健计划；[3]有情绪障碍需求的医疗保险/医疗补助及其他公共资助医疗保健计划；[4]共病障碍需求较低的私人医疗保健计划；[5]有大麻使用障碍需求的其他公共资助医疗保健计划；[6]有心理健康障碍需求的医疗保险/医疗补助医疗保健计划。这些集群之间的服务利用情况存在差异，心理治疗疗程（F = 8.55，p < 0.001）、精神科疗程（F = 22.72，p < 0.001）和团体治疗疗程（F = 10.76，p < 0.001）的集群均值存在差异。
本研究强调了对物质使用障碍和心理健康障碍进行全面综合治疗的重要性，特别是对服务不足社区的人群。医疗保健覆盖范围作为影响就医机会的社会经济因素，在区分治疗需求和利用情况方面至关重要。
