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Association between trajectories of buprenorphine treatment and emergency department and in-patient utilization.

Lo-Ciganic WH, Gellad WF, Gordon AJ, Cochran G, Zemaitis MA, Cathers T, Kelley D, Donohue JM. Association between trajectories of buprenorphine treatment and emergency department and in-patient utilization. Addiction (Abingdon, England). 2016 May 1; 111(5):892-902.

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BACKGROUND AND AIMS: Uncertainty about optimal treatment duration for buprenorphine opioid agonist therapy may lead to substantial variation in provider and payer decision-making regarding treatment course. We aimed to identify distinct trajectories of buprenorphine use and examine outcomes associated with these trajectories to guide health system interventions regarding treatment length. DESIGN: Retrospective cohort study. SETTING: US Pennsylvania Medicaid. PATIENTS: A total of 10 945 enrollees aged 18-64 years initiating buprenorphine treatment between 2007 and 2012. MEASUREMENTS: Group-based trajectory models were used to identify trajectories based on monthly proportion of days covered with buprenorphine in the 12 months post-treatment initiation. We used separate multivariable Cox proportional hazard models to examine associations between trajectories and time to first all-cause hospitalization and emergency department (ED) visit within 12 months after the first-year treatment. FINDINGS: Six trajectories [Bayesian information criterion (BIC)  =  -86 246.70] were identified: 24.9% discontinued buprenorphine <  3 months, 18.7% discontinued between 3 and 5 months, 12.4% discontinued between 5 and 8 months, 13.3% discontinued >  8 months, 9.5% refilled intermittently and 21.2% refilled persistently for 12 months. Persistent refill trajectories were associated with an 18% lower risk of all-cause hospitalizations [hazard ratio (HR)  =  0.82, 95% confidence interval (CI)  =  0.70-0.95] and 14% lower risk of ED visits (HR  =  0.86, 95% CI  =  0.78-0.95) in the subsequent year, compared with those discontinuing between 3 and 5 months. CONCLUSIONS: Six distinct buprenorphine treatment trajectories were identified in this population-based low-income Medicaid cohort in Pennsylvania, USA. There appears to be an association between persistent use of buprenorphine for 12 months and lower risk of all-cause hospitalizations/emergency department visits.

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