Therapeutic Relationships Between Veterans and Buprenorphine Providers and Effects on Treatment Retention

Details

• Personal Author:
  Arndt S ; Carnahan RM ; Charlton M ; Field W ; Lund BC ; Vakkalanka JP ; Ward MM
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Alcoholic Beverages Environmental Exposure Men Neoplasms Occupational Health Risk Assessment Risk Factors Safety Staff Development Tobacco Products Women

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• Keywords:
  Access/Demand/Utilization Of Services Alcohol Author Keywords: VA Healthcare System Chemical Dependency Chemicals Drugs Exposure Levels Humans Mental Health Metastatic Disease Military Personnel Pharmaceuticals: Prescribing/Use/Costs Risk Factors Rural Health Substance Abuse: Alcohol Therapeutic Agents Tobacco Training Tumors

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• ISSN:
  0017-9124
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Iowa ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  392-402
• Volume:
  57
• Issue:
  2
• NIOSHTIC Number:
  nn:20064271
• Citation:
  Health Serv Res 2022 Apr; 57(2):392-402
• Contact Point Address:
  Jayamalathi Priyanka Vakkalanka, Department of Emergency Medicine, University of Iowa, Carver College of Medicine, 200 Hawkins Drive, RCP 1008, Iowa City, IA 52242, USA
• Email:
  priyanka-vakkalanka@uiowa.edu
• CAS Registry Number:
  Buprenorphine (CAS RN 52485-79-7)
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Iowa
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Health Services Research
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:633fa8e1e9556a89cc155dde4139cc5b3260a8f8c9cb1a1319ced98bfd97a9dc80be6e115a0f2195352f652bbb42ac7f71ff2427d4b4b088dcc119de600b730f
• Download URL:
  https://stacks.cdc.gov/view/cdc/222770/cdc_222770_DS1.pdf
• File Type:
  [PDF - 1.02 MB ]