Influence of social vulnerability on buprenorphine treatment and opioid overdoses after an opioid-related emergency department visit among commercially insured and Medicare Advantage beneficiaries

商业保险和 Medicare Advantage 受益人在阿片类药物相关急诊就诊后，社会脆弱性对丁丙诺啡治疗和阿片类药物过量的影响

• 批准号: 10615419
• 负责人: Maria Anne Stevens
• 金额: $ 4.28万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10615419
• 关键词: Influence; social; vulnerability; buprenorphine; treatment

PROJECT SUMMARY/ABSTRACT Opioid overdoses continue to increase and disproportionately influence people experiencing greater social risk factors. Buprenorphine is a first-line treatment for opioid use disorder (OUD) that decreases opioid overdoses, especially when initiated in the emergency department (ED)— a high volume point-of-care. However, buprenorphine treatment inequities exist in and outside of the ED, and methodological challenges make it difficult to identify vulnerable populations with OUD who may benefit from improved access to, and quality of, buprenorphine treatment. The social vulnerability index (SVI), developed by the Centers for Disease Control and Prevention (CDC), is a measure that identifies vulnerable populations by capturing social risk factors in a region that influence health. A composite score is derived based on an area’s: 1) socioeconomic status; 2) household composition and disability; 3) minority status and language; 4) housing and transportation. Studies that examined the influence of area-level social risk factors on buprenorphine treatment and opioid overdoses were state specific or limited to county-level measures. No studies have examined the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit in people with OUD who have commercial or Medicare Advantage (aged and disabled) health insurance. This study will deploy the SVI at the residential zip-code level to investigate the influence of social vulnerability on buprenorphine treatment and opioid overdoses following an opioid-related ED visit using claims data (OptumLabs® Data Warehouse) from people with commercial or Medicare Advantage health insurance. Aim 1 will employ Cox hazard regression analysis to assess whether social vulnerability is associated with time to initiating buprenorphine treatment. Aim 2 will estimate the effect of social vulnerability on buprenorphine treatment retention for at least 180 days, as well as eight other buprenorphine treatment quality measures from the American Society of Addiction Medicine (ASAM), using generalized estimating equations (GEE). Aim 3 will estimate the effect of prescribing practices on opioid overdoses using GEE. The results from this study will serve as a model for future research and inform targeted policy and clinical levers that improve access to, and quality of, buprenorphine treatment, as well as opioid- related outcomes, among people with OUD experiencing greater social risk factors.

项目摘要/摘要 阿片类药物过量继续增加并不成比例地影响人们的经历 更大的社会风险因素。丁丙诺啡是阿片类药物使用障碍（OUD）的一线治疗方法 这会减少阿片类药物过量，尤其是在急诊科（ED）发起时 - 高量的护理点。但是，丁丙诺啡治疗不平等存在于内外 急诊室和方法论上的挑战使得很难确定 OUD可能会从改善丁丙诺啡治疗的获得和质量中受益的人。 由疾病控制中心开发的社会脆弱性指数（SVI） 预防（CDC）是一种通过捕获社会风险来识别弱势人群的措施 影响健康的地区的因素。基于区域的综合分数是：1） 社会经济地位； 2）家庭组成和残疾； 3）少数群体的地位和语言； 4）住房和运输。研究了地区级别社会风险的影响的研究 丁丙诺啡治疗和阿片类药物过量的因素是特异性或限制的 县级措施。没有研究检查社会脆弱性对 丁丙诺啡治疗和阿片类药物相关的ED访问后的阿片类药物过量 与拥有商业或医疗保险优势（老年和残疾）健康保险的Oud。 这项研究将在居民拉链代码级别部署SVI，以研究 丁丙诺啡治疗和阿片类药物相关后的阿片类药物过量的社会脆弱性 ED使用索赔数据（optumlabs®DataWarehouse）访问有商业人或 Medicare Advantage健康保险。 AIM 1将采用COX危害回归分析 评估社会脆弱性是否与启动丁丙诺啡治疗的时间有关。 AIM 2将估计社会脆弱性对丁丙诺啡治疗保留的影响 至少180天，以及其他八个丁丙诺啡治疗质量指标 美国成瘾医学学会（ASAM），使用广义估计方程（GEE）。 AIM 3将估算使用GEE的处方实践对阿片类药物过量剂的影响。这 这项研究的结果将成为未来研究的模型，并为有针对性的政策和 临床杠杆可改善丁丙诺啡治疗的获取和质量，以及阿片类药物 相关的结果，在有更大的社会风险因素的人中。