Journal article
Therapeutic relationships between Veterans and buprenorphine providers and effects on treatment retention
Health services research, Vol.57(2), pp.392-402
12/18/2021
DOI: 10.1111/1475-6773.13919
PMCID: PMC8928033
PMID: 34854083
Abstract
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.
Details
- Title: Subtitle
- Therapeutic relationships between Veterans and buprenorphine providers and effects on treatment retention
- Creators
- Jayamalathi Priyanka Vakkalanka - Department of Epidemiology University of Iowa College of Public Health Iowa City Iowa USA, Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USABrian C Lund - Department of Epidemiology University of Iowa College of Public Health Iowa City Iowa USA, Center for Comprehensive Access and Delivery Research and Evaluation Iowa City Veterans Affairs Health Care System Iowa City Iowa USAStephan Arndt - Department of Biostatistics University of Iowa College of Public Health Iowa City Iowa USA, Department of Psychiatry University of Iowa Carver College of Medicine Iowa City Iowa USAWilliam Field - Department of Occupational and Environmental Health University of Iowa College of Public Health Iowa City Iowa USAMary Charlton - Department of Epidemiology University of Iowa College of Public Health Iowa City Iowa USAMarcia M Ward - Department of Health Management and Policy University of Iowa College of Public Health Iowa City Iowa USARyan M Carnahan - Department of Epidemiology University of Iowa College of Public Health Iowa City Iowa USA
- Resource Type
- Journal article
- Publication Details
- Health services research, Vol.57(2), pp.392-402
- DOI
- 10.1111/1475-6773.13919
- PMID
- 34854083
- PMCID
- PMC8928033
- NLM abbreviation
- Health Serv Res
- ISSN
- 0017-9124
- eISSN
- 1475-6773
- Grant note
- DOI: 10.13039/100000125, name: National Institute for Occupational Safety and Health, award: T42OH008491; DOI: 10.13039/100000026, name: National Institute on Drug Abuse, award: 1R36DA050878‐01
- Language
- English
- Date published
- 12/18/2021
- Academic Unit
- Psychiatry; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Nursing; Injury Prevention Research Center
- Record Identifier
- 9984216622602771
Metrics
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