Expanding Treatment of Opioid Dependence Among the Privately Insured

扩大私人受保人对阿片类药物依赖的治疗

基本信息

批准号：
8287681
负责人：
Susan H Busch
金额：
$ 7.46万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-15 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8287681
关键词：
Advisory Committees Affect Attitude Behavioral Buprenorphine Caring Congresses Crime Decision Making Dose Drug usage Employment Evidence based treatment FDA approved Frequencies Goals HIV Health Health Services Health Services Research Hepatitis C Transmission Heroin Individual Industry Insurance Insurance Benefits Insurance Carriers Insurance Coverage Intervention Interview Laws Lead Left Marketing Measures Mental Health Methadone Methods National Institute of Drug Abuse Online Systems Opiate Addiction Opioid Pattern Pharmacologic Substance Pharmacotherapy Policies Population Prevalence Price Public Health Publishing Regulation Relative (related person)Reporting Research Respondent Risk Series Services Substance abuse problem Surveys Time U-Series Cooperative Agreements Uninsured United States addiction adverse outcome base cost criminal behavior design economic cost health care quality impaired driving performance improved parity preference prescription opioid public health relevance substance abuse treatment willingness to pay

项目摘要

DESCRIPTION (provided by applicant): While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. The availability of buprenorphine, an opioid dependence treatment approved by the FDA in 2002 with similar efficacy to methadone, was expected to lead to increased treatment rates. Although treatment rates have increased somewhat, they remain alarmingly low, leaving the majority of affected individuals at risk for adverse consequences including financial hardship, under-employment, transmission of hepatitis C and HIV, impaired driving, and crime. Restrictive insurance benefits for substance abuse may partially explain low treatment rates among the 53 percent of opioid dependent individuals with private insurance. The aim of the newly-enacted federal substance abuse parity law is to equalize private coverage for behavioral and physical illnesses. This law, which will be implemented in January 2010, has the potential to substantially affect treatment patterns for opioid dependence. However, other access-related factors are also likely to be relevant. Almost no research has focused specifically on barriers to treatment among the privately insured, and these individuals may have different financial constraints, time costs, and attitudes towards treatment compared with uninsured or publicly insured opioid dependent individuals. We propose two specific aims: (1) to study the effects of federal substance abuse parity on use of opioid dependence treatment financed by private insurance and (2) to estimate the relative importance of attributes of opioid dependence treatment on privately insured individuals' decision to enter treatment. First, we will compare treatment utilization by individuals newly covered by federal substance abuse parity regulations beginning in 2010 with treatment utilization by individuals already covered under pre-existing state substance abuse parity laws. We will adapt current substance abuse identification, treatment initiation, and treatment engagement measures to compare treatment patterns for these two groups before and after federal parity implementation. Second, we will conduct an analysis of demand for treatment by eliciting opioid dependent individuals' preferences for price and non-price related treatment attributes. We will conduct qualitative interviews to identify treatment attributes that affect the decision to enter treatment. Next, we will field a web-based survey of treatment-seeking and non-treatment-seeking opioid dependent individuals with private insurance to elicit information on the relative value of different treatment attributes and to estimate how improvements in treatment options will affect treatment rates. Both the IOM Report Improving the Quality of Health Care for Mental Health and Substance- Use Conditions and NIDA's 2004 Blue Ribbon Task Force on Health Services Research identified a pressing need to improve receipt of effective services in real world settings. To transform care for opioid dependence, it is vital to identify the effects of both benefit expansion and attributes of treatment on utilization rates. PUBLIC HEALTH RELEVANCE: Opioid dependence is a major public health concern in the United States, with economic costs estimated at $21 billion per year. While evidence-based treatments for opioid dependence are available, only 15 percent of affected individuals receive treatment. With the goal of increasing treatment rates, this project aims to evaluate the effects of federal parity on rates of use for opioid dependence treatment and to estimate how improving treatment options will affect rates of use among the 53 percent of opioid dependent individuals with private insurance.

描述（由申请人提供）：虽然可以使用基于循证的阿片类药物依赖性治疗方法，但只有15％的受影响的人接受治疗。丁丙诺啡的可用性是FDA在2002年批准的阿片类药物依赖治疗，其功效与美沙酮相似，预计将导致治疗率提高。尽管治疗率有所增加，但它们仍然令人震惊，使大多数受影响的人面临不利后果的风险，包括财务困难，就业不足，乙型肝炎和艾滋病毒的传播，驾驶受损和犯罪。滥用药物的限制性保险福利可能会部分解释53％的私人保险依赖类药物的治疗率。新成立的联邦药物滥用宗教法的目的是均等行为和身体疾病的私人承保范围。该法律将于2010年1月实施，有可能影响阿片类药物依赖的治疗模式。但是，其他与访问相关的因素也可能相关。几乎没有研究专门针对私人保险人的治疗障碍，与未保险或公开保险的阿片类药物相比，这些人可能对治疗的财务限制，时间成本和对治疗的态度不同。我们提出了两个具体的目的：（1）研究联邦滥用药物均等对使用私人保险资助的阿片类药物依赖治疗的影响，以及（2）估计阿片类药物依赖治疗属性对私人保险人对私人疗法的决定的相对重要性。首先，我们将比较从2010年开始被联邦药物滥用奇偶校验法规的个人与已经存在的州毒品滥用偶然法律所涵盖的个人的治疗利用。我们将适应当前的药物滥用识别，治疗启动和治疗参与措施，以比较联邦平价实施之前和之后的这两组的治疗模式。其次，我们将通过引起阿片类药物依赖人对价格和非价格相关的治疗属性的偏好来对治疗需求进行分析。我们将进行定性访谈，以确定影响进入治疗决定的治疗属性。接下来，我们将对具有私人保险的寻求治疗和寻求治疗的阿片类药物依赖性个人进行基于网络的调查，以获取有关不同治疗属性相对价值的信息，并估算治疗方案的改善将如何影响治疗率。 IOM报告都提高了心理健康和物质使用条件的医疗保健质量，以及NIDA 2004年的蓝带卫生服务工作组，确定了在现实世界中提高有效服务的紧迫需求。为了改变对阿片类药物依赖性的护理，至关重要的是要确定益处扩展和治疗属性对利用率的影响。公共卫生相关性：阿片类药物依赖是美国的主要公共卫生问题，经济成本估计为每年210亿美元。虽然可以使用基于循证的阿片类药物依赖性治疗方法，但只有15％的受影响的人接受治疗。以提高治疗率的目的，该项目旨在评估联邦平价对阿片类药物依赖治疗率的影响，并估计改善治疗方案将如何影响53％的阿片类药物患有私人保险的人的使用率。