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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1060 — Opioid Agonist Treatment (OAT) for Opioid Dependence: Trends in Use of Buprenorphine and Patient and Facility Factors Related to OAT receipt

Oliva EM (VA Palo Alto), Trafton JA (VA Palo Alto), Sox-Harris A (VA Palo Alto), Gordon AJ (Pittsburgh VAMC)

Objectives:
Opioid agonist treatment (OAT), either through a specialized licensed clinic setting using methadone or buprenorphine (C-OAT) or office-based setting using buprenorphine (O-OAT), is an effective and evidence-based treatment for opioid dependence that is mandated to be available at all VHA medical centers. The low number of C-OAT facilities available to Veterans (n = 52) presents a barrier to OAT access; thus, expansion in O-OAT has been encouraged. This study will examine trends in access to O-OAT care over time (fiscal year [FY] 2004-2009), variability in OAT access across facilities, and patient and facility factors related to variability in utilization.

Methods:
To examine trends in access to O-OAT over time, we examined VA administrative data from the National Patient Care Database, the Decision Support System pharmacy files, and the Pharmacy Benefits files. FY2008 data were linked with specialty substance use disorder program data from the FY2008 Drug and Alcohol Program Survey to examine variability in OAT access across facilities and patient and facility factors related to variability in OAT utilization (e.g., gender, services) using mixed-effects, logistic regression models with random facility effects.

Results:
Buprenorphine utilization increased steadily over time. In FY2004, 300 patients were prescribed buprenorphine at 34 facilities. In FY2009, 4823 patients were prescribed buprenorphine at 189 facilities. The number of Veterans with opioid dependence diagnoses also increased over time; however, the actual proportion of opioid dependent patients receiving OAT remained stable at 27%. FY2008 data suggest substantial variability in OAT utilization with 44% of facilities underutilizing OAT (i.e., ?5% of eligible patients received OAT). Patient-level predictors of OAT receipt included being male, age 56 or older, and not having a dual-diagnosis. Facility-level predictors of OAT receipt included having more staff with prescribing privileges and offering services for women and on the weekends and weeknights.

Implications:
O-OAT utilization is increasing; however, a finite proportion of opioid dependent patients receive OAT (27%) with wide facility variation in utilization. Patient- and facility-level interventions may help improve rates of OAT receipt.

Impacts:
These data will motivate implementation efforts to increase the proportion of opioid dependent patients receiving OAT, including addressing barriers on a facility-level based on site-specific barriers identified.


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