Differential Effect of Implementing Office Based Addiction Treatment in Primary Care on OUD Treatment across Sex and Race or Ethnicity in the PROUD Trial

Document Type

Conference Proceeding

Publication Date

2-1-2025

Publication Title

Drug Alcohol Depend

Keywords

buprenorphine, opiate, access to treatment, adult, Caucasian, conference abstract, controlled study, drug therapy, ethnicity, female, Hispanic, human, major clinical study, male, nurse training, primary medical care, race, randomized controlled trial, salary, sex, topical drug administration, treatment duration

Abstract

Drug Category: Opiates/Opioids Topic: Treatment Abstract Detail: Clinical - Experimental Abstract Category: Original Research Aim: Women and Black and Hispanic individuals with opioid use disorder (OUD) are less likely to receive medication treatment. The PROUD trial demonstrated that nurse care management of OUD in primary care (PC) increased OUD medication treatment compared to usual care (UC). This report describes findings regarding the impact of the intervention across sex, race, and ethnicity. Methods: Six health systems (TX, FL, MI, NY, WA) each provided 2 PC clinics randomized to UC or the PROUD intervention, consisting of (a) full-time nurse salary, (b) nurse training and technical assistance, and (c) ≥3 PC providers who prescribed buprenorphine. The main outcome was patient-years of OUD medication treatment per 10,000 PC patients (“patient-years of treatment”), a clinic-level measure reflecting treatment access and duration. Mixed-effect models evaluated patient-years of treatment testing for effect modification by (1) sex or (2) race and ethnicity, adjusting for baseline values of the outcome in sub-groups. Exploratory analyses describe differences between PROUD and UC in the change from pre- to post-randomization in the percent of PC patients who received any OUD medication treatment, pathways to treatment and duration of treatment. Results: At baseline, PROUD and UC clinic samples were 59.3-64.0% women, 18.5-18.9% Black, 26.4–33.4% Hispanic, and 31.6–41.3% white. The intervention increased patient-years of treatment among men (13.7; 95% CI: 5.8, 21.7) but not women (2.9; -4.3, 10.2); interaction p-value 0.045. Despite no significant interaction between the intervention and race or ethnicity (p=0.22), there was a large increase in patient-years of treatment for white patients in PROUD compared to UC clinics (35.6; 9.4, 61.8), but not for Black or Hispanic patients (0.0; -25.6, 25.7 and 1.8; -23.9, 27.4). Percentages of PC patients treated increased more in PROUD than UC, but increases were lower for women and Black or Hispanic patients: women, 0.11%; men, 0.29%; Black, Hispanic, and white patients, 0.08%, 0.09%, and 0.30%, respectively, suggesting differences in treatment access. Conclusions: PROUD’s implementation of nurse care management for OUD, while increasing OUD treatment overall, did not overcome disparities in OUD treatment in PC. Additional interventions are necessary to increase OUD treatment in women, Black and Hispanic patients. Financial Support: National Drug Abuse Treatment Clinical Trials Network (CTN-0074), UG1 DA040314, UG1 DA015831, UG1 DA013035, UG1 DA013720, HHSN271201400028C, 75N95019D00013

Volume

267

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