Community-Based Medications First for Opioid Use Disorder - Care Utilization and Mortality Outcomes.

IF 5.1 Q1 SUBSTANCE ABUSE Substance Abuse and Rehabilitation Pub Date : 2024-09-14 eCollection Date: 2024-01-01 DOI:10.2147/SAR.S475807
Caleb J Banta-Green, Mandy D Owens, Jason R Williams, Anthony S Floyd, Wendy Williams-Gilbert, Susan Kingston
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Abstract

Purpose: A large treatment gap exists for people who could benefit from medications for opioid use disorder (MOUD). People OUD accessing services in harm reduction and community-based organizations often have difficulty engaging in MOUD at opioid treatment programs and traditional health care settings. We conducted a study to test the impacts of a community-based medications first model of care in six Washington (WA) State communities that provided drop-in MOUD access.

Participants and methods: Participants included people newly prescribed MOUD. Settings included harm reduction and homeless services programs. A prospective cohort analysis tested the impacts of the intervention on MOUD and care utilization. Intervention impacts on mortality were tested via a synthetic comparison group analysis matching on demographics, MOUD history, and geography using WA State agency administrative data.

Results: 825 people were enrolled in the study of whom 813 were matched to state records for care utilization and outcomes. Cohort analyses indicated significant increases for days' supply of buprenorphine, months with any MOUD, and months with any buprenorphine for people previously on buprenorphine (all results p<0.05). Months with an emergency department overdose did not change. Months with an inpatient hospital stay increased (p<0.05). The annual death rate in the first year for the intervention group was 0.45% (3 out of 664) versus 2.2% (222 out of 9893) in the comparison group in the 12 months; a relative risk of 0.323 (95% CI 0.11-0.94).

Conclusion: Findings indicated a significant increase in MOUD for the intervention group and a lower mortality rate relative to the comparison group. The COVID-19 epidemic and rapid increase in non-pharmaceutical-fentanyl may have lessened the intervention impact as measured in the cohort analysis. Study findings support expanding access to a third model of low barrier MOUD care alongside opioid treatment programs and traditional health care settings.

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基于社区的阿片类药物使用障碍药物先行治疗--护理利用率和死亡率结果。
目的:对于那些可以从阿片类药物使用障碍(MOUD)药物治疗中获益的人来说,存在着巨大的治疗缺口。接受减低伤害和社区组织服务的阿片类药物滥用症患者通常很难在阿片类药物治疗项目和传统医疗机构接受阿片类药物滥用症治疗。我们开展了一项研究,在华盛顿州(WA)六个社区测试基于社区的药物先行护理模式的影响,这些社区提供随到随治的 MOUD 服务:参与者包括新开具 MOUD 的患者。环境包括减低伤害和无家可归者服务计划。一项前瞻性队列分析检验了干预措施对 MOUD 和护理利用率的影响。干预措施对死亡率的影响则通过使用西澳大利亚州机构的行政数据对人口统计学、MOUD 历史和地理位置进行匹配的合成对比组分析进行测试:结果:825 人参加了研究,其中 813 人与州政府记录的护理利用率和结果相匹配。队列分析表明,以前服用过丁丙诺啡的人服用丁丙诺啡的天数、服用任何 MOUD 的月数和服用任何丁丙诺啡的月数均有显著增加(所有结果均为负值):研究结果表明,与对比组相比,干预组的 MOUD 显著增加,死亡率降低。COVID-19 的流行和非药物芬太尼的快速增长可能会降低队列分析中衡量的干预效果。研究结果支持在阿片类药物治疗项目和传统医疗机构之外,扩大第三种低障碍 MOUD 护理模式的使用范围。
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发文量
9
审稿时长
16 weeks
期刊最新文献
Patient Perceived Impact of Outpatient Group Substance Use Disorder Treatment in a Hybrid Model or Virtual-Only Model Relative to In-Person Delivery. Enhancing Outcomes in Opioid Use Disorder Treatment: An Economic Evaluation of Improving Medication Adherence for Buprenorphine Through Blister-Packaging. A Framework for a New Paradigm of Opioid Drug Tapering Using Adjunct Drugs. Incidence, Timing and Social Correlates of the Development of Opioid Use Disorder Among Clients Seeking Treatment for an Alcohol Use Problem: Changes Over the Three Waves of the Opioid Epidemic. Community-Based Medications First for Opioid Use Disorder - Care Utilization and Mortality Outcomes.
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