PDF(Pubmed)
Abstract：
UNASSIGNED: Timely and reliable dispensing of buprenorphine is critical to accessing treatment for opioid use disorder (OUD). Racial and ethnic inequities in OUD treatment access are well described, but it remains unclear if inequities persist at the point of dispensing.
UNASSIGNED: We analyzed data from a U.S. telephone audit that measured restricted buprenorphine dispensing in community pharmacies, defined as inability to fill a buprenorphine prescription requested by a \"secret shopper.\" Using the Index of Concentration at the Extremes (ICE), we constructed county-level measures of racial, ethnic, economic, and racialized economic (joint racial and economic segregation) segregation. Logistic regression models evaluated the association of ICE measures and restricted buprenorphine dispensing, adjusting for county type (urban vs. rural) and pharmacy type (chain vs. independent).
UNASSIGNED: Among 858 pharmacies surveyed in 473 counties, pharmacies in the most ethnically segregated and economically deprived counties had 2.66 times the odds (95 % CI: 1.41, 5.17) of restricting buprenorphine dispensing, compared to pharmacies in the most privileged counties after adjustment. Pharmacies in counties with high racialized economic segregation (quintile 2 and 3) also had higher odds of restricting buprenorphine dispensing (aOR 3.09 [95 % CI 1.7, 5.59]; aOR 2.11 [95 % CI 1.17, 3.98]). Similar associations were observed for economic segregation (aOR: 2.18 [95 % CI: 1.21, 3.99]), but not ethnic (0.59 [0.34, 1.05]) or racial (0.61 [0.35, 1.07]) segregation alone.
UNASSIGNED: Restricted buprenorphine dispensing was most pronounced in socially and economically disadvantaged communities, potentially exacerbating gaps in OUD treatment access. Policy interventions should target both prescribing and dispensing capacity to advance pharmacoequity.
UNASSIGNED: We analyzed data from a U.S. telephone audit that measured restricted buprenorphine dispensing in community pharmacies, defined as inability to fill a buprenorphine prescription requested by a \"secret shopper.\" Using the Index of Concentration at the Extremes (ICE), we constructed county-level measures of racial, ethnic, economic, and racialized economic (joint racial and economic segregation) segregation. Logistic regression models evaluated the association of ICE measures and restricted buprenorphine dispensing, adjusting for county type (urban vs. rural) and pharmacy type (chain vs. independent).
UNASSIGNED: Among 858 pharmacies surveyed in 473 counties, pharmacies in the most ethnically segregated and economically deprived counties had 2.66 times the odds (95 % CI: 1.41, 5.17) of restricting buprenorphine dispensing, compared to pharmacies in the most privileged counties after adjustment. Pharmacies in counties with high racialized economic segregation (quintile 2 and 3) also had higher odds of restricting buprenorphine dispensing (aOR 3.09 [95 % CI 1.7, 5.59]; aOR 2.11 [95 % CI 1.17, 3.98]). Similar associations were observed for economic segregation (aOR: 2.18 [95 % CI: 1.21, 3.99]), but not ethnic (0.59 [0.34, 1.05]) or racial (0.61 [0.35, 1.07]) segregation alone.
UNASSIGNED: Restricted buprenorphine dispensing was most pronounced in socially and economically disadvantaged communities, potentially exacerbating gaps in OUD treatment access. Policy interventions should target both prescribing and dispensing capacity to advance pharmacoequity.
摘要：
■丁丙诺啡的及时和可靠的分配对于获得阿片类药物使用障碍（OUD）的治疗至关重要。OUD治疗获得方面的种族和族裔不平等得到了很好的描述，但目前尚不清楚不平等现象是否在分配时持续存在。
■我们分析了来自美国电话审计的数据，该数据测量了社区药房中限制的丁丙诺啡配药，定义为无法填写“秘密购物者”要求的丁丙诺啡处方。\“使用极端浓度指数(ICE)，我们构建了县级的种族衡量标准，民族,经济,和种族化的经济（种族和经济的联合隔离）隔离。Logistic回归模型评估了ICE措施和限制丁丙诺啡分配的关联，调整县类型(城市与农村)和药房类型(连锁与独立)。
■在473个县调查的858家药店中，在种族隔离和经济匮乏的县，药房限制丁丙诺啡配药的几率是2.66倍（95％CI：1.41，5.17），与调整后最特权县的药店相比。具有高种族经济隔离（五分位数2和3）的县的药房限制丁丙诺啡分配的可能性也较高（aOR3.09[95％CI1.7，5.59]；aOR2.11[95％CI1.17，3.98]）。经济隔离也观察到了类似的关联(AOR：2.18[95%CI：1.21，3.99])，但不是种族（0.59[0.34,1.05]）或种族（0.61[0.35,1.07]）单独隔离。
■丁丙诺啡限制配药在社会和经济上处于不利地位的社区最为明显，可能加剧OUD治疗准入方面的差距。政策干预应同时针对处方和配药能力，以促进药物公平性。
■我们分析了来自美国电话审计的数据，该数据测量了社区药房中限制的丁丙诺啡配药，定义为无法填写“秘密购物者”要求的丁丙诺啡处方。\“使用极端浓度指数(ICE)，我们构建了县级的种族衡量标准，民族,经济,和种族化的经济（种族和经济的联合隔离）隔离。Logistic回归模型评估了ICE措施和限制丁丙诺啡分配的关联，调整县类型(城市与农村)和药房类型(连锁与独立)。
■在473个县调查的858家药店中，在种族隔离和经济匮乏的县，药房限制丁丙诺啡配药的几率是2.66倍（95％CI：1.41，5.17），与调整后最特权县的药店相比。具有高种族经济隔离（五分位数2和3）的县的药房限制丁丙诺啡分配的可能性也较高（aOR3.09[95％CI1.7，5.59]；aOR2.11[95％CI1.17，3.98]）。经济隔离也观察到了类似的关联(AOR：2.18[95%CI：1.21，3.99])，但不是种族（0.59[0.34,1.05]）或种族（0.61[0.35,1.07]）单独隔离。
■丁丙诺啡限制配药在社会和经济上处于不利地位的社区最为明显，可能加剧OUD治疗准入方面的差距。政策干预应同时针对处方和配药能力，以促进药物公平性。
