Buprenorphine Treatment at 11 Years: Trends in an Urban Community Health Center. Tiffany Lu, MD AMERSA Conference Washington DC November 4, 2017
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1 Buprenorphine Treatment at 11 Years: Trends in an Urban Community Health Center Tiffany Lu, MD AMERSA Conference Washington DC November 4, 2017
2 Disclosures None
3 Introduction Buprenorphine is an effective treatment for opioid use disorder (OUD) in primary care settings Treatment retention is a key predictor in effectively managing OUD as chronic disease Robust primary care-based buprenorphine treatment retains >50% of patients at 6 months Ensuring consistent treatment retention over time may be challenging as primary care-based buprenorphine treatment expands Stein et al 2005; Cunningham et al 2008; Alford et al 2011
4 Objective To examine trends in buprenorphine treatment retention over 11 years in a Bronx community health center buprenorphine treatment program
5 Methods - Overview Retrospective cohort study Patients who initiated buprenorphine treatment at a Bronx community health center from January 2005 to September 2016 Treatment retention calculated for 1, 3, 6, 9, and 12 months Data extracted from electronic health records
6 Methods - Setting Buprenorphine treatment program embedded in general primary care since general internists over time, 1 clinical pharmacist No substance abuse counselors or support groups Patients eligible for buprenorphine treatment if 18 years, have OUD, insured or pay sliding scale fee If ongoing drug use, treatment intensification recommended Treatment may be terminated if buprenorphine diversion and/or refuse treatment intensification
7 Bronx
8
9 Methods Data Collection Electronic health records Demographic characteristics (age, sex, race/ethnicity) Buprenorphine prescription data (prescription dates, strength, dose, frequency, quantity)
10 Treatment Initiation Methods Dependent Variable Treatment retention defined by active buprenorphine prescription(s) during period of time following treatment initiation days days days days Contingent outcomes (i.e. 12 month-retention means retained at 1, 3, 6, and 9 months) days 1-month 3-month 6-month 9-month 12-month
11 Methods Independent Variables Year of buprenorphine treatment initiation Age (continuous) Sex (female, male) Race/ethnicity (Hispanic, non-hispanic black, non-hispanic white, non-hispanic other)
12 Methods Data Analyses Overall treatment retention at 1, 3, 6, 9, 12 months described Treatment retention examined by year of buprenorphine treatment initiation Adjusted for age, sex, race/ethnicity Linear trend over 11 years assessed by chi square for linear trend
13 Results (n=793) Demographic Characteristics Age, median (IQR) 46 (37, 52) Female, n(%) 191 (24) Race/ethnicity, n(%) Hispanic 377 (48) Non-Hispanic black 132 (17) Non-Hispanic white 62 (8) Non-Hispanic other 222 (28)
14 Overall Treatment Retention (n=793) % Patients Retained in Treatment 100% 80% 60% 40% 20% 0% 85.9% 72.0% 58.8% 49.6% 43.8% 1 month 3 months 6 months 9 months 12 months Treatment Retention
15 1-month Treatment Retention % Patients Retained in Treatment 100% 80% 60% 40% 20% 0% 80.1% (n=39) 88.3% 88.0% 88.1% 88.7% (n=176) (n=187) (n=125) (n=143) 75.4% (n=123) *Adjusted for age, sex, and race/ethnicity; P = 0.08 for linear trend
16 3-month Treatment Retention 100% 80% 60% 67.2% (n=39) 75.1% 75.2% 77.3% (n=176) (n=187) (n=125) 71.3% (n=143) 60.2% (n=123) 40% 20% 0% *Adjusted for age, sex, and race/ethnicity; P = 0.03 for linear trend
17 6-month Treatment Retention 100% 80% 60% 59.2% (n=39) 65.3% 64.2% (n=176) (n=187) 58.7% (n=125) 52.8% 47.9% (n=143) (n=123) 40% 20% 0% *Adjusted for age, sex, and race/ethnicity; P = for linear trend
18 12-month Treatment Retention 100% 80% 60% 40% 41.3% (n=39) 49.2% 48.2% (n=176) (n=187) 37.6% 40.7% 40.1% (n=125) (n=143) (n=123) 20% 0% *Adjusted for age, sex, and race/ethnicity; P = 0.07 for linear trend
19 Limitations Single site experience may not be generalizable to other primary care settings Did not have reliable prescriber information (3 separate EHR systems) Clinically, patients stretch medication, which was not taken into account in analyses
20 Conclusions Treatment retention was generally stable over time with a slight trend for worse outcomes Differences in treatment retention may reflect turnover and variable experiences among buprenorphine prescribers Support for buprenorphine treatment retention should be an important focus as programs expand in primary care settings
21 Acknowledgements Research Team Marcus Bachhuber, MD, MSHP Devin Thompson, MD Angela Giovanniello, PharmD Mary Gover, MD Joseph Deluca, MD Chinazo Cunningham, MD, MS Patients & Providers Funders NIH K24DA NIAID P30AI HRSA NCATS UL1 TR NYS DOH Empire Clinical Research Investigator Program NIDA-SGIM Mentored Training Award in SUD Treatment Science Dissemination Einstein-Montefiore GIM Fellowship
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