Geographic Access to Medication Assisted Treatment for Medicaid Enrollees with Opioid Use Disorder

患有阿片类药物使用障碍的医疗补助参与者获得药物辅助治疗的地理范围

• 批准号: 10200741
• 负责人: Coleman Drake
• 金额: $ 17.31万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200741
• 关键词: Address; Adherence; Administrator; Affect; American; Behavior Therapy; Buprenorphine; Catchment Area; Characteristics; Clinic; Code; Communities; Data; Enrollment; Ensure; Evaluation; Evidence based treatment; Expenditure; Face; Funding; Future; Geographic Locations; Geography; Goals; Grant; Health; Health Personnel; Health Services Accessibility; Hot Spot; Improve Access; Individual; Information Dissemination; Intervention; Investments; Knowledge; Literature; Low Income Population; Measurement; Measures; Medicaid; Mentorship; Methadone; Methods; Modeling; Naltrexone; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Patients; Pennsylvania; Pharmaceutical Preparations; Policies; Policy Maker; Population; Provider; Public Health; Recovery; Regulation; Research; Research Infrastructure; Research Personnel; Research Training; Resource Allocation; Resources; Rural; Services; Statistical Methods; Telemedicine; Time; Training; Transportation; Travel; Underserved Population; United States National Institutes of Health; Universities; Variant; Visit; Withdrawal Symptom; base; craving; effective intervention; geographic population; improved; innovation; medication-assisted treatment; methadone treatment; multidisciplinary; novel; opioid epidemic; opioid overdose; opioid use disorder; racial and ethnic; socioeconomic disadvantage; socioeconomics; spatial epidemiology; treatment program

Abstract Medication assisted treatment (MAT) is an evidence-based treatment for opioid use disorder (OUD) involving medication and behavioral therapy. Despite massive public expenditures to increase MAT access, MAT use remains low. Limited geographic access to MAT is a key barrier to OUD treatment because MAT requires frequent travel to providers. While expanding geographic access to MAT has been a policy priority, policymakers lack reliable, accurate measures of geographic access to MAT to guide planning efforts. The overall objectives of this proposal are to determine where and for whom geographic access to MAT is limited, and to examine how geographic access to MAT affects OUD-related health outcomes. The hypotheses are that geographic access to MAT is lower for disadvantaged socioeconomic groups, and that increased geographic access to MAT improves OUD-related health outcomes. The rationale for this project is that improved measurement of geographic access to MAT will enable policymakers to implement targeted, effective interventions to increase MAT access and use. The applicant will use Pennsylvania Medicaid claims to address the following specific aims: (1) Characterize variation in geographic access to MAT providers by car and public transit; (2) Identify patient and environmental characteristics associated with geographic access to MAT; and (3) Determine the impact of geographic access to MAT on MAT use and OUD-related overdoses. This application is innovative because it will apply novel methods for measuring geographic access to MAT, including disparities in access by public transit (which is particularly relevant to low-income populations in Medicaid), and use these measures with causal inference methods to estimate the causal effect of geographic access to MAT on OUD-related outcomes (including receipt of MAT and opioid overdoses). The proposed research is significant because it will enable policymakers and researchers to accurately identify small geographic areas where targeted interventions to improve geographic access to MAT are needed. It also will estimate how effective such interventions would be. Ultimately, the proposed research will create an evidence basis from which policymakers can prioritize interventions and allocate resources to efficiently increase geographic access to MAT. Through a training plan developed with the support of a multi-disciplinary mentorship team of NIH-funded investigators, this project will enable the applicant to develop a working knowledge of the treatment of OUD and expertise in MAT policy and geospatial methods. This project also places an emphasis on dissemination of results to state Medicaid administrators. Collectively, this project will prepare the applicant to transition to independence by submitting a R01 application to NIDA examining how various state policies affect OUD-related outcomes through their effects on geographic access to MAT.

抽象的 药物辅助治疗（MAT）是一种基于循证的阿片类药物使用障碍（OUD）治疗，涉及 药物和行为疗法。尽管大量公共支出以增加垫子访问，但使用垫 保持低。有限的地理访问垫是OUD处理的关键障碍，因为垫需要 经常前往提供商。虽然扩大地理访问对垫子一直是政策的优先事项，但 政策制定者缺乏可靠，准确的地理访问措施来指导计划工作。这 该提案的总体目标是确定地理访问垫的位置和谁的目标有限， 并检查地理访问如何影响与Oud相关的健康结果。假设是 对于处境不利的社会经济群体而言，该地理访问较低，这增加了 对垫子的地理访问可改善与Oud相关的健康结果。这个项目的理由是 改进了对垫子地理访问的测量，将使决策者能够实施有针对性的有效 干预措施以增加垫子访问和使用。申请人将使用宾夕法尼亚州医疗补助要求 解决以下特定目的：（1）表征通过汽车对垫子提供商的地理访问权限的变化 和公共交通； （2）确定与地理访问相关的患者和环境特征 垫; （3）确定对垫子的地理访问对垫子使用和与Oud相关的过量的影响。 该应用具有创新性，因为它将应用新颖的方法来衡量对垫子的地理访问， 包括公共交通的访问差异（这与低收入人群特别相关 Medicaid），并使用因果推理方法使用这些措施来估计地理的因果效应 访问与OUD相关结果的垫子（包括MAT和阿片类药物过量的接收）。提议 研究很重要，因为它将使决策者和研究人员准确地识别出小的 需要采取针对性干预措施以改善地理访问垫子的地理区域。它也会 估计这种干预措施的有效性。最终，拟议的研究将创建证据 决策者可以优先考虑干预措施并分配资源以有效增加的基础 地理访问垫子。通过在多学科的支持下制定的培训计划 NIH资助的调查人员的指导团队，该项目将使申请人能够开发一个工作 了解MAT政策和地理空间方法中OUD和专业知识的治疗知识。这个项目也是如此 强调向州医疗补助管理员传播结果。总体而言，这个项目将 通过向NIDA提交R01申请，准备申请人过渡到独立性 各种州政策通过对地理访问MAT的影响影响与Oud相关的结果。