Increasing access to medication-assisted treatment: Interactions between federal and state workforce policies

增加获得药物辅助治疗的机会：联邦和州劳动力政策之间的相互作用

基本信息

批准号：
9887141
负责人：
JOANNE E. SPETZ
金额：
$ 36.28万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-01 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9887141
关键词：
Address Advanced Practice Nurse Affect Area Buprenorphine Certified registered nurse anesthetist Clinical Nurse Specialists Clinical Trials Collaborations Communities County Cross-Sectional Studies Data Data Sources Effectiveness Environmental Policy Geographic Distribution Geography Goals Grant Growth Health Personnel Health Services Accessibility Healthcare Individual Laws Light Link Measures Medical Methadone Morbidity - disease rate Naltrexone Nurse Midwives Nurse Practitioners Observational Study Opiate Addiction Opioid Patients Pharmaceutical Preparations Pharmacotherapy Physician Assistants Physicians Policies Population Heterogeneity Provider Records Recovery Regulation Relapse Reporting Research Site Statutes and Laws Supervision System Tennessee Variant West Virginia addiction authority base buprenorphine treatment cost design econometrics economic cost federal policy medication-assisted treatment mortality multiple data sources opioid abuse opioid epidemic opioid mortality opioid overdose opioid use disorder overdose death population health programs response rural area rural underserved social stem success waiver

项目摘要

ABSTRACT / PROJECT SUMMARY Medication treatment for opioid use disorder is an important component of efforts to reduce the high social costs of prescription and non-prescription opioid abuse and mortality. This approach incorporates pharmacotherapies (e.g., buprenorphine, methadone, naltrexone) as part of treatment for opioid dependence. Buprenorphine’s effectiveness has been established in numerous studies and can be prescribed in office-based settings; thus, buprenorphine is particularly important to the expansion of access to medication treatment for opioid use disorder. However, the need for treatment dramatically outstrips the number of providers authorized to prescribe it, with particularly severe shortages of providers in rural areas. Many U.S. counties do not have a single provider. In response to the shortage of buprenorphine prescribers, two federal workforce policies were established in 2016: (1) allowing nurse practitioners and physician assistants to become authorized to prescribe buprenorphine in office-based settings, and (2) increasing the maximum number of patients that can be prescribed buprenorphine by a physician from 100 to 275. Legislation passed in 2018 allows other advanced practice nurses (nurse-midwives, clinical nurse specialists, and nurse-anesthetists) to prescribe buprenorphine as well. These policies are expected to increase access to medication treatment for opioid use disorder for thousands of individuals. However, the degree to which these policies achieve their goal will depend on other environmental and policy factors, most importantly state laws that regulate advanced practice clinicians’ medication prescribing. The proposed study will assess the impacts of these workforce policies on the supply and geographic reach of opioid treatment providers, with a focus on whether and how state policies facilitate or impede growth in available prescribers. The specific aims are: Aim 1: To measure the degree to which federal policies established in 2016 and 2018 impact the number and geographic distribution of clinicians with buprenorphine waivers. Aim 2: To determine whether state-level scope of practice regulations persistently moderate the effectiveness of federal policies aimed at increasing access to buprenorphine treatment. Aim 3: To assess whether expansions of the number and types of clinicians authorized to prescribe buprenorphine are associated with greater dispensing of buprenorphine. Data from multiple sources from 2016 through 2022 will be analyzed using econometric approaches that address state variation in regulations that may affect the growth of buprenorphine prescribers and utilization while controlling for other regulations and programs that might affect policy implementation. Findings from this research could be used to promote the harmonization of state and federal efforts to address the opioid crisis across the U.S. and in highly-impacted regions.

摘要/项目摘要阿片类药物使用障碍的药物治疗是减少高社会风险的重要组成部分该方法包括处方和非处方阿片类药物滥用和死亡率的成本。药物疗法（例如丁丙诺啡、美沙酮、纳曲酮）作为阿片类药物依赖治疗的一部分。丁丙诺啡的有效性已在众多研究中得到证实，并且可以在办公室开处方因此，丁丙诺啡对于扩大接受药物治疗的机会尤为重要然而，阿片类药物使用障碍的治疗需求远远超过了授权的提供者数量。由于农村地区医疗服务提供者的短缺尤其严重，美国许多县都没有医疗服务机构。单一提供商。为了应对丁丙诺啡处方者的短缺，制定了两项联邦劳动力政策 2016 年：(1) 允许执业护士和医师助理获得授权开具丁丙诺啡处方在办公室环境中，以及 (2) 增加可开处方的患者最大数量医生将丁丙诺啡从 100 增加到 275。2018 年通过的立法允许其他高级执业护士（护士助产士、临床护士专家和护士麻醉师）也可以开丁丙诺啡。预计政策将增加数千人获得阿片类药物使用障碍药物治疗的机会然而，这些政策实现其目标的程度将取决于其他环境因素。和政策因素，最重要的是规范高级实践信徒的药物处方的州法律。拟议的研究将评估这些劳动力政策对供应和地理范围的影响阿片类药物治疗提供者的调查，重点是国家政策是否以及如何促进或阻碍增长可用的处方者的具体目标是：目标 1：衡量 2016 年和 2018 年制定的联邦政策对数量和数量的影响程度受丁丙诺啡豁免青睐的地理分布。目标 2：确定州级执业范围法规是否持续调节有效性旨在增加丁丙诺啡治疗机会的联邦政策。目标 3：评估是否扩大授权开处方的主板数量和类型丁丙诺啡与丁丙诺啡的更大分配有关。将使用计量经济学方法对 2016 年至 2022 年多个来源的数据进行分析解决可能影响丁丙诺啡处方者和使用增长的各州法规差异同时控制可能影响政策实施的其他法规和计划。研究可用于促进州和联邦协调努力解决阿片类药物危机美国各地和受影响严重的地区。