TY - JOUR
AU - E. J. Hawkins
AU - C. A. Malte
AU - H. J. Hagedorn
AU - A. J. Gordon
AU - E. C. Williams
AU - R. S. Trim
AU - B. E. Blanchard
AU - A. Lott
AU - A. N. Danner
AU - A. J. Saxon
A1 - 
AB - OBJECTIVES: Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. METHODS: Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer. RESULTS: Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients. CONCLUSIONS: Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.
AD - From the Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA (EJH, CAM, ECW, AL, AND, AJS); Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA (EJH, CAM, HJH, AL, AND, AJS); HSR&D Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN (HJH); HSR&D Center of Innovation: Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT (AJG); Department of Health Services, University of Washington, Seattle, WA (ECW); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (EJH, BEB, AJS); Department of Psychiatry, University of Minnesota, Minneapolis, MN (HJH); Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AJG); Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Philadelphia VA Medical Center, Philadelphia, PA (RST).
AN - 38329814
BT - J Addict Med
C5 - Opioids & Substance Use; Healthcare Disparities
DA - Feb 8
DO - 10.1097/adm.0000000000001275
DP - NLM
ET - 20240208
JF - J Addict Med
LA - eng
N2 - OBJECTIVES: Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. METHODS: Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post-index year and retention the proportion who received buprenorphine for 180 days or longer. RESULTS: Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%-12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%-63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27-0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45-0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37-0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04-1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35-0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19-0.84) were less likely among non-Hispanic Black patients. CONCLUSIONS: Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.
PY - 2024
SN - 1932-0620
ST - Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care
T1 - Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care
T2 - J Addict Med
TI - Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.1097/adm.0000000000001275
VO - 1932-0620
Y1 - 2024
ER -