TY - JOUR
AU - L. Chen
AU - S. Sethi
AU - C. Poland
AU - C. Frank
AU - E. Tengelitsch
AU - J. Goldstick
AU - J. B. Sussman
AU - A. S. B. Bohnert
AU - L. A. Lin
A1 - 
AB - IMPORTANCE: Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. OBJECTIVE: To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. DESIGN, SETTING, AND PARTICIPANTS: This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. EXPOSURES: MOC engagement. MAIN OUTCOMES AND MEASURES: County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). RESULTS: Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. CONCLUSIONS AND RELEVANCE: In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
AD - Department of Biostatistics, University of Michigan, Ann Arbor.; Department of Anesthesiology, University of Michigan, Ann Arbor.; Department of Obstetrics, Gynecology and Reproductive Health, Michigan State University, East Lansing.; Department of Family Medicine, University of Michigan, Ann Arbor.; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor.; Department of Psychiatry, University of Michigan, Ann Arbor.; Injury Prevention Center, University of Michigan, Ann Arbor.; Department of Emergency Medicine, University of Michigan, Ann Arbor.; Department of Health Behavior and Health Education, University of Michigan, Ann Arbor.; Division of General Internal Medicine, University of Michigan, Ann Arbor.; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor.
AN - 38127344
BT - JAMA Netw Open
C5 - Opioids & Substance Use; Education & Workforce
CP - 12
DA - Dec 1
DO - 10.1001/jamanetworkopen.2023.49103
DP - NLM
ET - 20231201
IS - 12
JF - JAMA Netw Open
LA - eng
N2 - IMPORTANCE: Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. OBJECTIVE: To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. DESIGN, SETTING, AND PARTICIPANTS: This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. EXPOSURES: MOC engagement. MAIN OUTCOMES AND MEASURES: County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100 000 population). RESULTS: Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9 990 000. A total of 5 070 000 (50.8%) were female, 1 410 000 (14.1%) were African American or Black, 530 000 (5.3%) were Hispanic or Latino, and 7 470 000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100 000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100 000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P = .004) monthly increase after engagement compared with before. CONCLUSIONS AND RELEVANCE: In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.
PY - 2023
SN - 2574-3805
SP - e2349103
ST - Prescriptions for Buprenorphine in Michigan Following an Education Intervention
T1 - Prescriptions for Buprenorphine in Michigan Following an Education Intervention
T2 - JAMA Netw Open
TI - Prescriptions for Buprenorphine in Michigan Following an Education Intervention
U1 - Opioids & Substance Use; Education & Workforce
U3 - 10.1001/jamanetworkopen.2023.49103
VL - 6
VO - 2574-3805
Y1 - 2023
ER -