Jayamalathi Priyanka Vakkalanka1,2, Brian C Lund1,3, Stephan Arndt4,5, William Field6, Mary Charlton1, Marcia M Ward7, Ryan M Carnahan1. 1. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 3. Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA. 4. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA. 5. Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 6. Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, Iowa, USA. 7. Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa, USA.
Abstract
OBJECTIVE: To examine the extent to which there was any therapeutic relationship between Veterans and their initial buprenorphine provider and whether the presence of this relationship influenced treatment retention. DATA SOURCES: National, secondary administrative data used from the Veterans Health Administration (VHA), 2008-2017. STUDY DESIGN: Retrospective cohort study. The primary exposure was a therapeutic relationship between the Veteran and buprenorphine provider, defined as the presence of a previous visit or medication prescribed by the provider in the 2 years preceding buprenorphine treatment initiation. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. DATA COLLECTION/EXTRACTION METHODS: Adult Veterans (age ≥ 18 years) diagnosed with opioid use disorder and treated with buprenorphine or buprenorphine/naloxone within the VHA system were included in this study. We excluded those receiving buprenorphine patches, those with documentation of a metastatic tumor diagnosis within 2 years prior to buprenorphine initiation, and those without geographical information on rurality. PRINCIPAL FINDINGS: A total of 28,791 Veterans were included in the study. Within the overall study sample, 56.3% (n = 16,206) of Veterans previously had at least one outpatient encounter with their initial buprenorphine provider, and 24.9% (n = 7174) of Veterans previously had at least one prescription from that provider in the 2 years preceding buprenorphine initiation. There was no significant or clinically meaningful association between therapeutic relationship history and treatment retention when defined as visit history (aHR: 0.99; 95% CI: 0.96, 1.02) or medication history (aHR: 1.03; 95% CI: 1.00, 1.07). CONCLUSIONS: Veterans initiating buprenorphine frequently did not have a therapeutic history with their initial buprenorphine provider, but this relationship was not associated with treatment retention. Future work should investigate how the quality of Veteran-provider therapeutic relationships influences opioid use dependence management and whether eliminating training requirements for providers might affect access to buprenorphine, and subsequently, treatment initiation and retention.
OBJECTIVE: To examine the extent to which there was any therapeutic relationship between Veterans and their initial buprenorphine provider and whether the presence of this relationship influenced treatment retention. DATA SOURCES: National, secondary administrative data used from the Veterans Health Administration (VHA), 2008-2017. STUDY DESIGN: Retrospective cohort study. The primary exposure was a therapeutic relationship between the Veteran and buprenorphine provider, defined as the presence of a previous visit or medication prescribed by the provider in the 2 years preceding buprenorphine treatment initiation. The primary outcome was treatment discontinuation, evaluated as 14 days of absence of medication from initiation through 1 year. DATA COLLECTION/EXTRACTION METHODS: Adult Veterans (age ≥ 18 years) diagnosed with opioid use disorder and treated with buprenorphine or buprenorphine/naloxone within the VHA system were included in this study. We excluded those receiving buprenorphine patches, those with documentation of a metastatic tumor diagnosis within 2 years prior to buprenorphine initiation, and those without geographical information on rurality. PRINCIPAL FINDINGS: A total of 28,791 Veterans were included in the study. Within the overall study sample, 56.3% (n = 16,206) of Veterans previously had at least one outpatient encounter with their initial buprenorphine provider, and 24.9% (n = 7174) of Veterans previously had at least one prescription from that provider in the 2 years preceding buprenorphine initiation. There was no significant or clinically meaningful association between therapeutic relationship history and treatment retention when defined as visit history (aHR: 0.99; 95% CI: 0.96, 1.02) or medication history (aHR: 1.03; 95% CI: 1.00, 1.07). CONCLUSIONS: Veterans initiating buprenorphine frequently did not have a therapeutic history with their initial buprenorphine provider, but this relationship was not associated with treatment retention. Future work should investigate how the quality of Veteran-provider therapeutic relationships influences opioid use dependence management and whether eliminating training requirements for providers might affect access to buprenorphine, and subsequently, treatment initiation and retention.
Authors: S Bakken; W L Holzemer; M A Brown; G M Powell-Cope; J G Turner; J Inouye; K M Nokes; I B Corless Journal: AIDS Patient Care STDS Date: 2000-04 Impact factor: 5.078
Authors: Jayamalathi Priyanka Vakkalanka; Brian C Lund; Stephan Arndt; William Field; Mary Charlton; Marcia M Ward; Ryan M Carnahan Journal: Health Serv Res Date: 2021-12-18 Impact factor: 3.734
Authors: Jan Gryczynski; Shannon Gwin Mitchell; Jerome H Jaffe; Kevin E O'Grady; Yngvild K Olsen; Robert P Schwartz Journal: J Subst Abuse Treat Date: 2013-10-14
Authors: Jayamalathi Priyanka Vakkalanka; Brian C Lund; Stephan Arndt; William Field; Mary Charlton; Marcia M Ward; Ryan M Carnahan Journal: Health Serv Res Date: 2021-12-18 Impact factor: 3.734