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- Title
Prescriptions for Buprenorphine in Michigan Following an Education Intervention.
- Authors
Chen, Liying; Sethi, Sheba; Poland, Cara; Frank, Christopher; Tengelitsch, Elizabeth; Goldstick, Jason; Sussman, Jeremy B.; Bohnert, Amy S. B.; Lin, Lewei
- Abstract
This cohort study evaluates the association between Michigan Opioid Collaborative service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. Key Points: Question: Can buprenorphine prescribing be increased by the implementation of a statewide, flexible outreach and educational program that addresses the wide range of barriers faced by different communities? Findings: In this cohort study of 83 Michigan counties, receipt of services from the Michigan Opioid Collaborative was associated with county-level increases in density of buprenorphine prescribers and patients filling prescriptions for buprenorphine. Meaning: These findings suggest flexible outreach and free clinician and community education delivered by a multidisciplinary team is a scalable model for expanding access to buprenorphine in diverse communities. 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.
- Subjects
MICHIGAN; STATISTICAL significance; SUBSTANCE abuse; HEALTH services accessibility; BUPRENORPHINE; POPULATION geography; REGRESSION analysis; HEALTH outcome assessment; MEDICAL care use; HUMAN services programs; DRUGS; DRUG prescribing; DRUG monitoring; DESCRIPTIVE statistics; RESEARCH funding; PHYSICIAN practice patterns; SOCIODEMOGRAPHIC factors; DATA analysis software; LONGITUDINAL method
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349103
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49103