Julie Dupouy1,2, Sandy Maumus-Robert3, Yohann Mansiaux3, Antoine Pariente3,4, Maryse Lapeyre-Mestre5,6. 1. Département Universitaire de Médecine Générale, Université de Toulouse, Faculté de Médecine, Toulouse, France, julie.dupouy@dumg-toulouse.fr. 2. Inserm UMR1027, Université de Toulouse III, Faculté de Médecine, 37 allées Jules Guesde, Toulouse, France, julie.dupouy@dumg-toulouse.fr. 3. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France. 4. CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie médicale, Bordeaux, France. 5. Inserm UMR1027, Université de Toulouse III, Faculté de Médecine, 37 allées Jules Guesde, Toulouse, France. 6. CEIP-Addictovigilance, Service de Pharmacologie Clinique, Faculté de Médecine, 37 allées Jules Guesde, Toulouse, France.
Abstract
BACKGROUND: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a 'French model' facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. OBJECTIVES: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. MATERIALS AND METHODS: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009-2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. RESULTS: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. CONCLUSIONS: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.
BACKGROUND: In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a 'French model' facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. OBJECTIVES: Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. MATERIALS AND METHODS: Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009-2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. RESULTS: Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (n = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. CONCLUSIONS: Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.
Authors: Marie Rouillon; Catherine Laporte; Pierre Ingrand; Philippe Castéra; Paolo Di Patrizio; Nassir Messaadi; Philippe Binder; Julie Dupouy Journal: Eur J Gen Pract Date: 2021-12 Impact factor: 1.904
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