Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records

Sheryl Ker,1,* Jennifer Hsu,2,* Anisha Balani,1,* Sankha Subhra Mukherjee,1 A John Rush,3– 5 Mehreen Khan,2 Sara Elchehabi,2 Seth Huffhines,2 Dustin DeMoss,2,6 Miguel E Rentería,1 Joydeep Sarkar1 1Holmusk Technologies, Inc., New York, NY, USA; 2John Peter Smith Health Network...

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Autores principales: Ker S, Hsu J, Balani A, Mukherjee SS, Rush AJ, Khan M, Elchehabi S, Huffhines S, DeMoss D, Rentería ME, Sarkar J
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Publicado: Dove Medical Press 2021
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spelling oai:doaj.org-article:c9a5e3ea4d2c4a1492555822fbabdc892021-12-02T19:41:29ZFactors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records1178-2021https://doaj.org/article/c9a5e3ea4d2c4a1492555822fbabdc892021-10-01T00:00:00Zhttps://www.dovepress.com/factors-that-affect-patient-attrition-in-buprenorphine-treatment-for-o-peer-reviewed-fulltext-article-NDThttps://doaj.org/toc/1178-2021Sheryl Ker,1,* Jennifer Hsu,2,* Anisha Balani,1,* Sankha Subhra Mukherjee,1 A John Rush,3– 5 Mehreen Khan,2 Sara Elchehabi,2 Seth Huffhines,2 Dustin DeMoss,2,6 Miguel E Rentería,1 Joydeep Sarkar1 1Holmusk Technologies, Inc., New York, NY, USA; 2John Peter Smith Health Network, Fort Worth, TX, USA; 3Department of Psychiatry, Duke-National University of Singapore (NUS), Singapore; 4Duke University School of Medicine, Durham, NC, USA; 5Texas Tech Health Sciences Center, Odessa, TX, USA; 6University of North Texas Health Science Center/Texas Christian University, Fort Worth, TX, USA*These authors contributed equally to this workCorrespondence: Miguel E Rentería; Joydeep SarkarHolmusk Technologies, Inc., 4th Floor, 54 Thompson St, New York, NY, 10012, USAEmail miguel.renteria@holmusk.com; joydeep.sarkar@holmusk.comPurpose: To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition.Patients and Methods: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at > 37 days following the last recorded visit. Survival analyses and predictive modelling were used.Results: Retention was consistently 2– 3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression – Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and non-psychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%.Conclusion: Of all the OUD patients who began BUP, 50– 75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.Keywords: opioids, buprenorphine, buprenorphine dosing, treatment engagement, treatment retention, treatment dropout, predictorsKer SHsu JBalani AMukherjee SSRush AJKhan MElchehabi SHuffhines SDeMoss DRentería MESarkar JDove Medical Pressarticleopioidsbuprenorphinebuprenorphine dosingtreatment engagementtreatment retentiontreatment dropoutpredictorsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 17, Pp 3229-3244 (2021)
institution DOAJ
collection DOAJ
language EN
topic opioids
buprenorphine
buprenorphine dosing
treatment engagement
treatment retention
treatment dropout
predictors
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle opioids
buprenorphine
buprenorphine dosing
treatment engagement
treatment retention
treatment dropout
predictors
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Ker S
Hsu J
Balani A
Mukherjee SS
Rush AJ
Khan M
Elchehabi S
Huffhines S
DeMoss D
Rentería ME
Sarkar J
Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
description Sheryl Ker,1,* Jennifer Hsu,2,* Anisha Balani,1,* Sankha Subhra Mukherjee,1 A John Rush,3– 5 Mehreen Khan,2 Sara Elchehabi,2 Seth Huffhines,2 Dustin DeMoss,2,6 Miguel E Rentería,1 Joydeep Sarkar1 1Holmusk Technologies, Inc., New York, NY, USA; 2John Peter Smith Health Network, Fort Worth, TX, USA; 3Department of Psychiatry, Duke-National University of Singapore (NUS), Singapore; 4Duke University School of Medicine, Durham, NC, USA; 5Texas Tech Health Sciences Center, Odessa, TX, USA; 6University of North Texas Health Science Center/Texas Christian University, Fort Worth, TX, USA*These authors contributed equally to this workCorrespondence: Miguel E Rentería; Joydeep SarkarHolmusk Technologies, Inc., 4th Floor, 54 Thompson St, New York, NY, 10012, USAEmail miguel.renteria@holmusk.com; joydeep.sarkar@holmusk.comPurpose: To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition.Patients and Methods: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at > 37 days following the last recorded visit. Survival analyses and predictive modelling were used.Results: Retention was consistently 2– 3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression – Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and non-psychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%.Conclusion: Of all the OUD patients who began BUP, 50– 75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.Keywords: opioids, buprenorphine, buprenorphine dosing, treatment engagement, treatment retention, treatment dropout, predictors
format article
author Ker S
Hsu J
Balani A
Mukherjee SS
Rush AJ
Khan M
Elchehabi S
Huffhines S
DeMoss D
Rentería ME
Sarkar J
author_facet Ker S
Hsu J
Balani A
Mukherjee SS
Rush AJ
Khan M
Elchehabi S
Huffhines S
DeMoss D
Rentería ME
Sarkar J
author_sort Ker S
title Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
title_short Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
title_full Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
title_fullStr Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
title_full_unstemmed Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records
title_sort factors that affect patient attrition in buprenorphine treatment for opioid use disorder: a retrospective real-world study using electronic health records
publisher Dove Medical Press
publishDate 2021
url https://doaj.org/article/c9a5e3ea4d2c4a1492555822fbabdc89
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