title: Patterns and Quality of Buprenorphine Opioid Agonist Treatment in a Large Medicaid Program.
abstract: OBJECTIVE
  Use of buprenorphine - an effective treatment for opioid use disorders (OUDs) - has increased rapidly in recent years and is often financed by Medicaid. We investigated predictors of buprenorphine treatment, patterns of care, and quality of care in a large state Medicaid program.
  
  
  METHODS
  Data from Pennsylvania Medicaid from 2007 to 2012 provided information regarding diagnoses, demographic characteristics, enrollment, and use of inpatient and outpatient services, and prescription drugs. We identified adult enrollees using buprenorphine, and examined prevalence of OUD diagnosis and patterns of use (duration and dose) and quality of care (physician visits, receipt of behavioral health counseling, urine drug screens, and other prescription drug use). We use a mixed logistic regression model to examine enrollee characteristics associated with buprenorphine use.
  
  
  RESULTS
  The share of enrollees with OUD filling prescriptions for buprenorphine increased from 2985 (9.8%) to 12,691 (25.2%) from 2007 to 2012. Between 26.2 and 32.0% of enrollees using buprenorphine had no diagnosis of OUD, depending on the year. Only 60.1% of enrollees with buprenorphine use received at least one urine drug screen, 41.0% had behavioral health counseling services, and 34.7 and 38.0% had other opioid and benzodiazepine claims, respectively, concomitant with buprenorphine use. Quality of care was lower among those with no OUD diagnosis recorded. The mean daily doses of buprenorphine decreased over time. We found wide variation in likelihood of buprenorphine use among those with OUD based upon age, sex, and race.
  
  
  CONCLUSIONS
  Increases in buprenorphine treatment in a Medicaid population were observed across time; however, increases varied by age, sex, and rate, and the quality of care received seemed to be generally poor. The quality of the provision of buprenorphine treatment occurring in Medicaid populations should be further explored.
authors.affiliation: University of Pittsburgh School of Medicine (A.J.G., G.C., W.F.G.), Pittsburgh, PA; VA Pittsburgh Healthcare System (A.J.G., W.F.G.), Pittsburgh, PA; University of Pittsburgh Center for Pharmaceutical Policy and Prescribing (A.J.G., W.-H.L.-C., G.C., W.F.G., J.M.D.), Pittsburgh, PA; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh (J.M.D.), Pittsburgh, PA; University of Arizona, College of Pharmacy (W.-H.L.-C.), Tucson, AZ; University of Pittsburgh School of Social Work (G.C.), Pittsburgh, PA; Pennsylvania Department of Human Services (T.C., D.K.).
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Wei-Hsuan
authors.initials: WH
authors.lastname: Lo-Ciganic
authors.forename: Gerald
authors.initials: G
authors.lastname: Cochran
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.forename: Terri
authors.initials: T
authors.lastname: Cathers
authors.forename: David
authors.initials: D
authors.lastname: Kelley
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D055553:Prescription Drugs; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs; D002047:Buprenorphine