Specialty Provider Prescribing of Medications to Treat Opioid Use Disorder in Older Adults

专业医疗服务提供者开出治疗老年人阿片类药物使用障碍的药物

基本信息

批准号：
10543834
负责人：
Jonathan Cantor
金额：
$ 28.5万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10543834
关键词：
Academy Accident and Emergency department Adult Affect American Area Buprenorphine Caring Characteristics County Data Data Linkages Data Set Databases Diagnosis Disadvantaged Disease Disparity Drug Prescriptions Elderly Emergency department visit Ethnic Origin Event Exposure to Future Geographic Locations Geography Government Officials Growth Health Health Personnel Hospitalization Improve Access Inpatients Knowledge Licensing Life Expectancy Link Measures Medicaid Medicare Medicare claim Medicine Methadone Naltrexone Opioid Outcome Outpatients Overdose Overdose reduction Pain Patient-Focused Outcomes Patients Pattern Pharmaceutical Preparations Physical Dependence Policies Population Prevention Privatization Provider Public Health Quality of Care Race Records Reporting Research Substance Use Disorder Surveys Time Treatment Cost United States United States Centers for Medicare and Medicaid Services Variant aged beneficiary bundled payment chronic pain management experience geographic disparity health care disparity health care service utilization high risk human old age (65+)improved innovation inpatient service medical specialties medication for opioid use disorder mortality novel opioid epidemic opioid misuse opioid mortality opioid treatment program opioid use disorder overdose death payment population based prescription opioid response rural area rural counties sociodemographic disparity sociodemographics substance abuse treatment substance use substance use treatment treatment center treatment disparity treatment services young adult

项目摘要

Project Summary Drug overdose deaths that have included opioids have increased so rapidly over the past six years that the average life expectancy in the United States has declined. The national drug overdose rate for adults aged 65 and over increased by 7% from 2015 to 2016. Older adults may be at higher risk for opioid-related deaths and hospitalizations because they are more likely to start treatment for chronic pain and are also at higher risk for physical dependence. In 2017 the most commonly reported reason for opioid misuse in adults 50 and older was “relative physical pain”. In 2018, 80% of Americans with opioid use disorders (OUD) received no treatment; older adults are particularly disadvantaged. This despite the fact that medications for the treatment of opioid use disorder (MOUD) are an effective form of treatment. In 2017, 35 percent of substance use disorder (SUD) treatment facilities accepted Medicare as payment. Additionally, lack of geographic access to SUD treatment facilities is a broad problem with 85 percent of counties in the U.S. lacking a treatment center with an opioid treatment program. For older adults, access challenges may be exacerbated as approximately 25 percent of Americans older than age 65 live in a small town or other rural area; a rate that is higher than for younger adults. Rural areas also tend to have fewer SUD treatment facilities and higher rates of overdose. The data typically used to track the supply of licensed SUD treatment facilities– the National Survey of Substance Abuse Treatment Services– do not contain measures on the use of MOUD by providers at the facility nor does it contain geographic identifiers below the state. The overall objective of this R21 is to increase understanding of MOUD use by providers at SUD treatment facilities; whether variation in MOUD use at SUD facilities is associated with disparities in treatment for older adults; and how policies to improve access affect health care utilization among older adults. Our specific aims are to: Aim 1: Identify sociodemographic and geographic disparities in MOUD use for Medicare beneficiaries receiving OUD treatment in SUD treatment facilities. Aim 2: Identify disparities in health care utilization outcomes, including ED and inpatient care for overdoses, associated with SUD treatment facilities’ MOUD use rates. Aim 3: Evaluate the effect of state policies associated with OUD treatment on MOUD use rates for beneficiaries receiving treatment in SUD treatment facilities. The proposed R21 is a necessary first step to creating data linkages between a novel dataset of SUD treatment facilities, their providers, and claims data. We use the combined dataset to understand the use of MOUD by these facilities in the treatment of OUD for Medicare beneficiaries. Based on our results, in a future R01 we hope to develop the first ever OUD quality of care measures for older adults at treatment facilities.

项目摘要在过去的六年中，包括阿片类药物在内的药物过量死亡人数如此迅速地增加了美国的平均预期寿命下降。 65岁的成年人的国家药物过量率从2015年到2016年，超过7％。老年人可能面临阿片类药物相关死亡的风险较高，并且住院治疗，因为它们更有可能开始治疗慢性疼痛，并且也面临更高的风险身体依赖。在2017年，最常见的是50岁及以上成人阿片类药物的原因是“相对身体疼痛”。 2018年，有80％的美国人使用阿片类药物使用障碍（OUD）没有治疗;老年人特别处于不利地位。这个使命是治疗药物的事实阿片类药物使用障碍（MOUD）是一种有效的治疗形式。 2017年，有35％的药物使用障碍（SUD）治疗设施接受医疗保险作为付款。此外，缺乏地理访问SUD治疗设施是一个广泛的问题，其中85％美国的县缺乏阿片类药物治疗计划的治疗中心。对于老年人，访问挑战可能会加剧，因为大约25％的65岁以上的美国人生活在一个小的城镇或其他粗糙区域；比年轻人高的率。农村地区也往往更少治疗设施和更高的过量发生率。通常用于跟踪许可SUD的供应的数据治疗设施 - 全国对药物滥用治疗服务的调查 - 不包含有关的措施提供商在设施中使用MOUD，也没有包含州以下的地理标识符。这 R21的总体目的是增加提供者在SUD治疗中对MOUD使用的理解设施; SUD设施中MOUD使用的变化是否与老年治疗的差异有关成年人;以及改善获取的政策如何影响老年人的医疗保健利用。我们的具体目标是：目标1：确定用于Medicare受益人的MOUD使用中的社会人口统计学和地理差异在SUD治疗设施中接受OUD治疗。目标2：确定医疗保健利用结果的差异，包括ED和住院过量护理，与SUD治疗设施的MOUD使用率相关。目标3：评估与Oud处理相关的国家政策对MOUD使用率的影响受益人在SUD治疗设施中接受治疗。提出的R21是在SUD新颖数据集之间建立数据链接的必要第一步治疗设施，其提供者和索赔数据。我们使用组合数据集了解这些设施的MOUD用于治疗Medicare受益人的OUD。根据我们的结果，将来 R01，我们希望为治疗机构的老年人制定有史以来的第一个OUD护理质量措施。