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美国医疗补助参保者治疗阿片类药物使用障碍的药物使用情况分析
作者:小柯机器人 发布时间:2021/7/18 14:34:19

医疗补助成果分布式研究网络(MODRN)小组分析了2014-2018年美国11个州医疗补助参保者中用于治疗阿片类药物使用障碍的药物使用情况。这一研究成果于2021年7月13日发表在《美国医学会杂志》上。

关于医疗补助参保者阿片类药物使用障碍(OUD)治疗趋势的信息很有限。

为了研究多个州OUD药物使用情况和潜在的护理质量指标,2014-2018年,研究组进行了一项探索性系列横断面研究, 共招募了1024301名12-64岁的医疗补助参保者(不符合医保资格),符合OUD国际疾病分类第九修订版(ICD-9或ICD-10)代码。

每个州使用广义估计方程来估计参保者特征和结果测量流行率之间的关联,之后使用随机效应荟萃分析来进行全局估计。主要观察指标为使用治疗OUD的药物(丁丙诺啡、美沙酮或纳曲酮);质量良好的潜在指标(OUD连续用药180天、行为健康咨询、尿药试验);质量差的潜在指标(阿片类镇痛药和苯二氮卓类药物的处方)。

2018年,41.7%的医疗补助OUD参保者年龄在21至34岁之间,51.2%为女性,76.1%为非西班牙裔白人,50.7%通过医疗补助扩展获得资格,50.6%患有其他物质使用障碍。接受药物治疗的OUD患者的合并患病率从2014年的47.8%上升至2018年的57.1%。从2014-2015年到2017-2018年,各州接受180天连续用药治疗的参保者的总体患病率趋势没有显著变化。非西班牙裔黑人参保者的OUD药物使用率低于白人受试者。孕妇使用OUD药物的比例和用药连续性较高。

研究结果表明,在11个州的美国医疗补助参保者中,2014-2018年,用于治疗阿片类药物使用障碍的药物使用率增加。

附:英文原文

Title: Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018

Author: The Medicaid Outcomes Distributed Research Network (MODRN), Elizabeth Brown, Maik Schutze, Angela Taylor, David Jorgenson, Catherine McGuire, Alyssa Brown, Alice Middleton, Cynthia Woodcock, Marie LaPres, Lisa Cohn, Shannon Dowler, Emma Sandoe, Roderick Rose, Mary Applegate, Kendallyn Markman, Mark Rizzutti, Elizabeth Truex-Powell, Robert Ashmead, Aimee Mack, Emelie Bailey, David Kelley, A. Everette James, Monica Costlow, Michael Sharbaugh, Ashley Harrell, Lauryn Walker, James Becker, Cynthia Parsons, Yilin Cai, Steve Tyska, Kristen Voskuil, Julie M. Donohue, Marian P. Jarlenski, Joo Yeon Kim, Lu Tang, Katherine Ahrens, Lindsay Allen, Anna Austin, Andrew J. Barnes, Marguerite Burns, Chung-Chou H. Chang, Sarah Clark, Evan Cole, Dushka Crane, Peter Cunningham, David Idala, Stefanie Junker, Paul Lanier, Rachel Mauk, Mary Joan McDuffie, Shamis Mohamoud, Nathan Pauly, Logan Sheets, Jeffery Talbert, Kara Zivin, Adam J. Gordon, Susan Kennedy

Issue&Volume: 2021/07/13

Abstract:

Importance  There is limited information about trends in the treatment of opioid use disorder (OUD) among Medicaid enrollees.

Objective  To examine the use of medications for OUD and potential indicators of quality of care in multiple states.

Design, Setting, and Participants  Exploratory serial cross-sectional study of 1024301 Medicaid enrollees in 11 states aged 12 through 64 years (not eligible for Medicare) with International Classification of Diseases, Ninth Revision (ICD-9 or ICD-10) codes for OUD from 2014 through 2018. Each state used generalized estimating equations to estimate associations between enrollee characteristics and outcome measure prevalence, subsequently pooled to generate global estimates using random effects meta-analyses.

Exposures  Calendar year, demographic characteristics, eligibility groups, and comorbidities.

Main Outcomes and Measures  Use of medications for OUD (buprenorphine, methadone, or naltrexone); potential indicators of good quality (OUD medication continuity for 180 days, behavioral health counseling, urine drug tests); potential indicators of poor quality (prescribing of opioid analgesics and benzodiazepines).

Results  In 2018, 41.7% of Medicaid enrollees with OUD were aged 21 through 34 years, 51.2% were female, 76.1% were non-Hispanic White, 50.7% were eligible through Medicaid expansion, and 50.6% had other substance use disorders. Prevalence of OUD increased in these 11 states from 3.3% (290628 of 8737082) in 2014 to 5.0% (527983 of 10585790) in 2018. The pooled prevalence of enrollees with OUD receiving medication treatment increased from 47.8% in 2014 (range across states, 35.3% to 74.5%) to 57.1% in 2018 (range, 45.7% to 71.7%). The overall prevalence of enrollees receiving 180 days of continuous medications for OUD did not significantly change from the 2014-2015 to 2017-2018 periods (0.01 prevalence difference, 95% CI, 0.03 to 0.02) with state variability in trend (90% prediction interval, 0.08 to 0.06). Non-Hispanic Black enrollees had lower OUD medication use than White enrollees (prevalence ratio [PR], 0.72; 95% CI, 0.64 to 0.81; P<.001; 90% prediction interval, 0.52 to 1.00). Pregnant women had higher use of OUD medications (PR, 1.18; 95% CI, 1.11-1.25; P<.001; 90% prediction interval, 1.01-1.38) and medication continuity (PR, 1.14; 95% CI, 1.10-1.17, P<.001; 90% prediction interval, 1.06-1.22) than did other eligibility groups.

Conclusions and Relevance  Among US Medicaid enrollees in 11 states, the prevalence of medication use for treatment of opioid use disorder increased from 2014 through 2018. The pattern in other states requires further research.

DOI: 10.1001/jama.2021.7374

Source: https://jamanetwork.com/journals/jama/article-abstract/2781858

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex