Stewart Maureen T, Daily Shay M, Panas Lee, Feltus Sage R, Lee Margaret, Ritter Grant, Reif Sharon
Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (all authors).
Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston (Stewart, Feltus).
Psychiatr Serv. 2025 Sep 1;76(9):795-800. doi: 10.1176/appi.ps.20240373. Epub 2025 Jun 25.
The authors examined, separately for different racial-ethnic groups, whether use of medications for opioid use disorder (MOUD) increased more among people treated in a hub-and-spoke care model than among people treated in a non-hub-and-spoke model.
Comparative time-series analyses were performed with Washington State Medicaid claims (2017-2019) data for 115,911 enrollees to investigate MOUD use, stratified by care model and enrollee race-ethnicity.
Following implementation of the hub-and-spoke model, the proportions of enrollees with opioid use disorder receiving MOUD increased in all racial-ethnic groups. Buprenorphine use increased more among Black, Hispanic, and White enrollees treated in the hub-and-spoke model than among people of the same race-ethnicities treated in a non-hub-and-spoke model (beta range 0.56-0.93, p<0.05). However, within the hub-and-spoke model, rates of buprenorphine use increased more among White enrollees than among American Indian or Alaska Native (AI/AN) enrollees (β=0.84, p<0.001). Methadone use increased more among AI/AN enrollees treated in the hub-and-spoke model compared with AI/AN enrollees treated in a non-hub-and-spoke model (β=0.39, p<0.001).
Following implementation of the hub-and-spoke model, MOUD use increased for Medicaid enrollees of all race-ethnicities. The increase in MOUD use for Black, Hispanic, and White enrollees who received treatment in the hub-and-spoke model was greater than that for people of the same race-ethnicities treated in a non-hub-and-spoke model. Thus, the hub-and-spoke model may be a useful strategy to increase use of MOUD treatment.
作者分别针对不同种族-族裔群体，研究在中心-辐射式照护模式下接受治疗的人群中，用于阿片类物质使用障碍的药物（MOUD）的使用增加幅度是否大于非中心-辐射式模式下接受治疗的人群。
利用华盛顿州医疗补助计划（2017 - 2019年）中115,911名参保人的数据进行比较时间序列分析，以调查MOUD的使用情况，并按照护模式和参保人的种族-族裔进行分层。
在实施中心-辐射式模式后，所有种族-族裔群体中接受MOUD治疗的阿片类物质使用障碍参保人的比例均有所增加。在中心-辐射式模式下接受治疗的黑人、西班牙裔和白人参保人中，丁丙诺啡的使用增加幅度大于在非中心-辐射式模式下接受治疗的同种族-族裔人群（β范围为0.56 - 0.93，p<0.05）。然而，在中心-辐射式模式中，白人参保人中丁丙诺啡的使用增加率高于美国印第安人或阿拉斯加原住民（AI/AN）参保人（β = 0.84，p<0.001）。与在非中心-辐射式模式下接受治疗的AI/AN参保人相比，在中心-辐射式模式下接受治疗的AI/AN参保人中美沙酮的使用增加幅度更大（β = 0.39，p<0.001）。
在实施中心-辐射式模式后，所有种族-族裔的医疗补助计划参保人的MOUD使用均有所增加。在中心-辐射式模式下接受治疗的黑人、西班牙裔和白人参保人的MOUD使用增加幅度大于在非中心-辐射式模式下接受治疗的同种族-族裔人群。因此，中心-辐射式模式可能是增加MOUD治疗使用的一种有效策略。
