PDF(Pubmed)
Abstract：
Opioid use disorder (OUD) remains prevalent. Medications for OUD (MOUD) are standard care for pregnant and non-pregnant women. Previous research has identified barriers to MOUD for women with Medicaid but did not account for the type of MOUD (methadone vs. buprenorphine) or pregnancy status. We examined access to MOUD by treatment type for pregnant and non-pregnant women with Medicaid in Florida.
A secondary analysis of Florida \"secret-shopper\" data was conducted. Calls were made to clinicians from the 2018 Substance Abuse and Mental Health Services Administration provider list by women posing as either a pregnant or non-pregnant woman with OUD and Medicaid. We examined 546 calls to buprenorphine-waivered providers (BWP) and 139 to opioid treatment programs (OTP). Counts and percentages were used to describe caller success by type of treatment and pregnancy status. Chi-square tests were used to identify statistical differences.
Only 42 % of calls reached a treatment provider in Florida. Pregnant and non-pregnant women were less likely to obtain an appointment with Medicaid coverage by a BWP than an OTP (p < 0.01). Nearly 40 % of OTPs offered appointments to callers with Medicaid compared to only 17 % of BWPs. Both types of providers denied appointments more often for pregnant women. Thirty-eight percent of BWP\'s and 12 % of OTP\'s denied appointments to pregnant women using cash or Medicaid payment.
Our study demonstrates logistical and financial barriers to treatment for OUD among pregnant and non-pregnant women with Medicaid in Florida and highlights the need for improved systems of care.
A secondary analysis of Florida \"secret-shopper\" data was conducted. Calls were made to clinicians from the 2018 Substance Abuse and Mental Health Services Administration provider list by women posing as either a pregnant or non-pregnant woman with OUD and Medicaid. We examined 546 calls to buprenorphine-waivered providers (BWP) and 139 to opioid treatment programs (OTP). Counts and percentages were used to describe caller success by type of treatment and pregnancy status. Chi-square tests were used to identify statistical differences.
Only 42 % of calls reached a treatment provider in Florida. Pregnant and non-pregnant women were less likely to obtain an appointment with Medicaid coverage by a BWP than an OTP (p < 0.01). Nearly 40 % of OTPs offered appointments to callers with Medicaid compared to only 17 % of BWPs. Both types of providers denied appointments more often for pregnant women. Thirty-eight percent of BWP\'s and 12 % of OTP\'s denied appointments to pregnant women using cash or Medicaid payment.
Our study demonstrates logistical and financial barriers to treatment for OUD among pregnant and non-pregnant women with Medicaid in Florida and highlights the need for improved systems of care.
摘要：
背景：阿片类药物使用障碍（OUD）仍然普遍存在。OUD（MOUD）药物是孕妇和非孕妇的标准护理。以前的研究已经确定了医疗补助女性使用MOUD的障碍，但没有考虑MOUD的类型(美沙酮与丁丙诺啡）或怀孕状态。我们检查了在佛罗里达州接受医疗补助的孕妇和非孕妇的治疗类型对MOUD的访问。
方法：对佛罗里达州“秘密购物者”数据进行了二次分析。从2018年药物滥用和精神卫生服务管理局提供者名单中，女性冒充OUD和Medicaid孕妇或非孕妇，打电话给临床医生。我们检查了546个对丁丙诺啡豁免提供者（BWP）的呼叫和139个对阿片类药物治疗计划（OTP）的呼叫。计数和百分比用于描述按治疗类型和怀孕状态的呼叫者成功。使用卡方检验来确定统计学差异。
结果：只有42％的电话到达了佛罗里达州的治疗提供者。与OTP相比，孕妇和非孕妇获得BWP医疗补助保险的可能性较小（p<0.01）。近40％的OTP为Medicaid的来电者提供预约，而BWP中只有17％。这两种类型的提供者都拒绝更频繁地为孕妇预约。38％的BWP和12％的OTP拒绝使用现金或医疗补助付款的孕妇预约。
结论：我们的研究表明，在佛罗里达州接受医疗补助的孕妇和非孕妇中，治疗OUD的后勤和财务障碍，并强调需要改进护理系统。
方法：对佛罗里达州“秘密购物者”数据进行了二次分析。从2018年药物滥用和精神卫生服务管理局提供者名单中，女性冒充OUD和Medicaid孕妇或非孕妇，打电话给临床医生。我们检查了546个对丁丙诺啡豁免提供者（BWP）的呼叫和139个对阿片类药物治疗计划（OTP）的呼叫。计数和百分比用于描述按治疗类型和怀孕状态的呼叫者成功。使用卡方检验来确定统计学差异。
结果：只有42％的电话到达了佛罗里达州的治疗提供者。与OTP相比，孕妇和非孕妇获得BWP医疗补助保险的可能性较小（p<0.01）。近40％的OTP为Medicaid的来电者提供预约，而BWP中只有17％。这两种类型的提供者都拒绝更频繁地为孕妇预约。38％的BWP和12％的OTP拒绝使用现金或医疗补助付款的孕妇预约。
结论：我们的研究表明，在佛罗里达州接受医疗补助的孕妇和非孕妇中，治疗OUD的后勤和财务障碍，并强调需要改进护理系统。
