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Drug Alcohol Depend. 2020 Feb 1;207:107732. doi: 10.1016/j.drugalcdep.2019.107732. Epub 2019 Nov 15.

Prevalence and treatment of opioid use disorders among primary care patients in six health systems.

Author information

1
Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Health Services, United States. Electronic address: gwen.t.lapham@kp.org.
2
Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Pharmacy, United States.
3
Kaiser Permanente Washington Health Research Institute, United States.
4
The Emmes Company, United States.
5
National Institute on Drug Abuse Center for Clinical Trials Network, United States.
6
Boston University & Boston Medical Center Department of Medicine, Division of General Internal Medicine, United States.
7
Veteran Affairs Puget Sound Health Care System Center of Excellence in Substance Abuse Treatment and Education, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, United States.
8
Kaiser Permanente Northern California Division of Research, United States.
9
Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, United States.
10
Health Partners Institute, United States.
11
Multicare Health System, MultiCare Tacoma Central Family Medicine, United States.
12
Kaiser Permanente Colorado, Institute for Health Research, United States; Colorado Permanente Medical Group, Denver, CO, United States.
13
Kaiser Permanente Northwest Center for Health Research, United States.
14
Kaiser Permanente Washington Health Research Institute, United States; University of Washington, Department of Health Services, United States; University of Washington, Department of Medicine, United States.
15
Henry Ford Health System Center for Health Policy & Health Services Research, United States.
16
Multicare Health System, MultiCare Institute for Research and Innovation, United States.
17
Montefiore Medical Center Department of Medicine, United States; Montefiore Medical Center Division of General Internal Medicine, United States; Albert Einstein College of Medicine, Department of Medicine, Division of General Internal Medicine, United States.
18
Hennepin Healthcare, United States.
19
Montefiore Medical Center Department of Medicine, United States; Albert Einstein College of Medicine, Department of Medicine, Division of General Internal Medicine, United States.
20
Kaiser Permanente Southern California, Department of Research and Evaluation, United States.
21
University of Miami Miller, School of Medicine, Department of Public Health Sciences, United States.
22
University of Pittsburgh, School of Medicine, Division of General Internal Medicine, Center for Research on Health Care, United States.
23
New York University, School of Medicine, Department of Population Health and Department of Medicine, Division of General Internal Medicine and Clinical Innovation, United States.
24
University of Washington, Department of Medicine, United States.
25
McGovern Medical School at The University of Texas Health Science Center at Houston, United States.
26
Friends Research Institute, United States.
27
University of Massachusetts, Boston College of Nursing and Health Sciences, Boston, MA, United States.
28
University of Washington, Division of General Internal Medicine, United States.

Abstract

BACKGROUND:

The U.S. experienced nearly 48,000 opioid overdose deaths in 2017. Treatment of opioid use disorder (OUD) with buprenorphine is a recommended part of primary care, yet little is known about current U.S. practices in this setting. This observational study reports the prevalence of documented OUD and OUD treatment with buprenorphine among primary care patients in six large health systems.

METHODS:

Adults with ≥2 primary care visits during a three-year period (10/1/2013-9/30/2016) in six health systems were included. Data were obtained from electronic health record and claims data, with measures, assessed over the three-year period, including indicators for documented OUD from ICD 9 and 10 codes and OUD treatment with buprenorphine. The prevalence of OUD treatment was adjusted for age, gender, race/ethnicity, and health system.

RESULTS:

Among 1,368,604 primary care patients, 13,942 (1.0 %) had documented OUD, and among these, 21.0 % had OUD treatment with buprenorphine. For those with documented OUD, the adjusted prevalence of OUD treatment with buprenorphine varied across demographic and clinical subgroups. OUD treatment was lower among patients who were older, women, Black/African American and Hispanic (compared to white), non-commercially insured, and those with non-cancer pain, mental health disorders, greater comorbidity, and more opioid prescriptions, emergency department visits or hospitalizations.

CONCLUSIONS:

Among primary care patients in six health systems, one in five with an OUD were treated with buprenorphine, with disparities across demographic and clinical characteristics. Less buprenorphine treatment among those with greater acute care utilization highlights an opportunity for systems-level changes to increase OUD treatment.

KEYWORDS:

Buprenorphine; Health services research; Opioid use disorder; Primary care; Treatment

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