目的:评估参加使用丁丙诺啡-纳洛酮事先授权(PA)的健康计划的Medicare受益人与参加未使用PA的计划的受益人在阿片类药物使用障碍(OUD)治疗质量方面的差异。
方法:横断面观察研究,美国。在2012年3月至2017年7月期间,使用OUD连续登记受益人(71294)至少开具了一张丁丙诺啡-纳洛酮处方。
方法:接受乙肝检测的患者百分比,丙肝,HIV和肝功能;接受尿药筛选的患者百分比和尿药筛选的数量;连续使用丁丙诺啡-纳洛酮至少180天;苯二氮卓类药物的共同使用;有或没有OUD诊断的门诊就诊次数。
结果:PA与乙型肝炎检测的较低可能性显着相关[-3.5,95%置信区间(CI)=-4.4,-2.7]和C(-5.9,95%CI=-6.9,-4.9),但对于HIV检测(-1.1,95%CI=-2.5,0.4)或肝功能检测(1.3,95%CI=-0.1,2.7)是否存在差异,结果尚无定论.PA与尿液药物筛选的可能性较低(-25.5,95%CI=-26.8,-24.1)和较少的药物筛选(-2.5,95%CI=-3.0,-2.1)相关。关于连续使用丁丙诺啡-纳洛酮是否存在差异的结果尚无定论(0.3,95%CI=-1.2,1.8)。PA与门诊量较少(-2.1,95%CI=-3.0,-1.2)和OUD诊断的门诊量较少(-1.7,95%CI=-2.1,-1.3)相关。PA与丁丙诺啡-纳洛酮诱导前后服用苯二氮卓类药物的可能性较低(-28.9,95%CI=-29.6,-28.3),但在丁丙诺啡-纳洛酮诱导后仅使用苯二氮卓类药物的可能性较大(10.6,95%CI=9.3,11.8)。
结论:美国医疗保险患者接受丁丙诺啡-纳洛酮的事先授权,与未接受事先授权的患者相比,接受阿片类药物使用障碍的高质量治疗的可能性不大。
OBJECTIVE: To assess differences in the quality of opioid use disorder (OUD) treatment received by Medicare beneficiaries enrolled in health plans that used prior authorization (PA) for buprenorphine-naloxone compared with those enrolled in plans that did not use PA.
METHODS: Cross-sectional observational study, United States. Continuously enrolled beneficiaries (71 294) with an OUD who filled at least one prescription for buprenorphine-naloxone between March 2012 and July 2017.
METHODS: Percentage of patients tested for hepatis B, hepatis C, HIV and liver functioning; percentage of patients with urine drug screens and number of urine drug screens; continuous use of buprenorphine-naloxone for at least 180 days; co-use of benzodiazepines; number of outpatient visits with and without an OUD diagnosis.
RESULTS: PA was significantly associated with a lower likelihood of testing for hepatitis B [-3.5, 95% confidence interval (CI) = -4.4, -2.7] and C (-5.9, 95% CI = -6.9, -4.9), but the findings were inconclusive as to whether or not there was a difference in HIV (-1.1, 95% CI = -2.5, 0.4) or liver function testing (1.3, 95% CI = -0.1, 2.7). PA was associated with a lower likelihood of urine drug screening (-25.5, 95% CI = -26.8, -24.1) and with fewer drug screens (-2.5, 95% CI = -3.0, -2.1). Findings were inconclusive as to whether or not there was a difference in continuous use of buprenorphine-naloxone (0.3, 95% CI = -1.2, 1.8). PA was associated with fewer outpatient visits (-2.1, 95% CI = -3.0, -1.2) and fewer outpatient visits with an OUD diagnosis (-1.7, 95% CI = -2.1, -1.3). PA was associated with a lower likelihood of filling benzodiazepine prescriptions before and after buprenorphine-naloxone induction (-28.9, 95% CI = -29.6, -28.3) but a greater likelihood of only using benzodiazepines after buprenorphine-naloxone induction (10.6, 95% CI = 9.3, 11.8).
CONCLUSIONS: US Medicare patients subject to prior authorization for buprenorphine-naloxone are not more likely to receive high-quality treatment for opioid use disorder than patients not subject to prior authorization.