Hannah K Knudsen1, Michelle R Lofwall2, Lewei Allison Lin3, Sharon L Walsh4, Jamie L Studts5. 1. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 204, Lexington, KY, 40508, United States. Electronic address: hannah.knudsen@uky.edu. 2. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 203, Lexington, KY, 40508, United States. Electronic address: michelle.lofwall@uky.edu. 3. University of Michigan, Department of Psychiatry and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor MI, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States. Electronic address: leweil@med.umich.edu. 4. Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 202, Lexington, KY, 40508, United States. Electronic address: sharon.walsh@uky.edu. 5. Department of Behavioral Science, University of Kentucky, 127 Medical Behavioral Science Building, Lexington, KY, 40536-0086, United States. Electronic address: jamie.studts@uky.edu.
Abstract
BACKGROUND: Research on how US physicians individualize buprenorphine-naloxone treatment is limited. The current study uses conjoint analysis to examine the importance of current dose, visit frequency, clinical indicators, and payment type on office visit and dose adjustments during buprenorphine-naloxone treatment. METHODS: A national random sample of 776 US buprenorphine-prescribing physicians participated in a mailed survey between October 2015 and July 2018. The survey contained 16 patient vignettes describing: (1) current dose, (2) urine drug test (UDT) results and opioid blockade, (3) recent intravenous use, (4) visit attendance, (5) counseling adherence, (6) payment, and (7) visit schedule. Physicians rated how they would adjust office visits (0=definitely decrease to 5=no change to 10=definitely increase) and the dose (0=definitely decrease to 5=no change to 10=definitely increase). Descriptive statistics were calculated for the vignette responses. Conjoint analysis was used to estimate relative importance scores and part-worth utilities. RESULTS: Across the vignettes, the mean response for adjusting office visits was 7.43 (SD = 1.69), indicating a tendency to increase the frequency of visits. UDT results/opioid blockade, intravenous use, and current visit schedule had the greatest importance scores for office visit adjustments. The mean response for adjusting the dose was 5.48 (SD = 1.69), corresponding with a tendency toward not changing dose. Current dose, UDT results/opioid blockade, and intravenous use had the largest importance scores for dose adjustment. CONCLUSIONS: Physicians individualized buprenorphine-naloxone treatment in response to hypothetical patient attributes by changing visit frequency and, to a lesser extent, modifying maintenance dose, in a manner generally consistent with current practice guidelines.
BACKGROUND: Research on how US physicians individualize buprenorphine-naloxone treatment is limited. The current study uses conjoint analysis to examine the importance of current dose, visit frequency, clinical indicators, and payment type on office visit and dose adjustments during buprenorphine-naloxone treatment. METHODS: A national random sample of 776 US buprenorphine-prescribing physicians participated in a mailed survey between October 2015 and July 2018. The survey contained 16 patient vignettes describing: (1) current dose, (2) urine drug test (UDT) results and opioid blockade, (3) recent intravenous use, (4) visit attendance, (5) counseling adherence, (6) payment, and (7) visit schedule. Physicians rated how they would adjust office visits (0=definitely decrease to 5=no change to 10=definitely increase) and the dose (0=definitely decrease to 5=no change to 10=definitely increase). Descriptive statistics were calculated for the vignette responses. Conjoint analysis was used to estimate relative importance scores and part-worth utilities. RESULTS: Across the vignettes, the mean response for adjusting office visits was 7.43 (SD = 1.69), indicating a tendency to increase the frequency of visits. UDT results/opioid blockade, intravenous use, and current visit schedule had the greatest importance scores for office visit adjustments. The mean response for adjusting the dose was 5.48 (SD = 1.69), corresponding with a tendency toward not changing dose. Current dose, UDT results/opioid blockade, and intravenous use had the largest importance scores for dose adjustment. CONCLUSIONS: Physicians individualized buprenorphine-naloxone treatment in response to hypothetical patient attributes by changing visit frequency and, to a lesser extent, modifying maintenance dose, in a manner generally consistent with current practice guidelines.
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