Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder

作者：Stephen W. Patrick, Michael R. Richards, William D. Dupont, Elizabeth A. McNeer, Melinda Beeuwkes Buntin, Peter Martin, Matthew M. Davis, Corey S. Davis, Katherine E. Hartmann, Ashley A. Leech, Kim S. Lovell, Bradley D. Stein, William O. Cooper · 发表于：JAMA Network Open · 年份：2020 · DOI：10.1001/jamanetworkopen.2020.13456 · 被引用次数：139 · 研究领域：Prenatal Substance Exposure Effects、Opioid Use Disorder Treatment、Maternal Mental Health During Pregnancy and Postpartum

Importance: Medications for opioid use disorder, including buprenorphine hydrochloride and methadone hydrochloride, are highly effective at improving outcomes for individuals with the disorder. For pregnant women, use of these medications also improves pregnancy outcomes, including the risk of preterm birth. Despite the known benefits of medications for opioid use disorder, many pregnant and nonpregnant women with the disorder are not receiving them. Objective: To determine whether pregnancy and insurance status are associated with a woman's ability to obtain an appointment with an opioid use disorder treatment clinician. Design, Setting, and Participants: In this cross-sectional study with random assignment of clinicians and simulated-patient callers (performed in "secret shopper" format), outpatient clinics that provide buprenorphine and methadone were randomly selected from publicly available treatment lists in 10 US states (selected for variability in opioid-related outcomes and policies) from March 7 to September 5, 2019. Pregnant vs nonpregnant woman and private vs public insurance assigned randomly to callers to create unique patient profiles. Simulated patients called the clinics posing as pregnant or nonpregnant women to obtain an initial appointment with a clinician. Main Outcomes and Measures: Appointment scheduling, wait time, and out-of-pocket costs. Results: A total of 10 871 unique patient profiles were assigned to 6324 clinicians. Among all women, 2312 of 3420...