Pediatrics open science · 2025
Opioid use disorder medications among youth in primary care: Subgroup analysis of the PROUD trial.
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Chavez Laura J, Yu Onchee, Wartko Paige D, Braciszewski Jordan M, Glass Joseph E, Horigian Viviana E, Arnsten Julia H, Murphy Mark T, Stotts Angela L, Bagley Sarah M, Lapham Gwen T, Samet Jeffrey H
Аннотация
OBJECTIVE: Medications for opioid use disorder (OUD) are under-utilized among adolescents and young adults ("youth"). Offering buprenorphine or naltrexone in primary care settings may reduce barriers to their use among youth. We conducted a secondary, patient-level analysis of the PROUD cluster-randomized clinical trial, which tested the implementation of a nurse care management intervention to support prescribing OUD medications.
METHODS: 12 primary care clinics from 6 health systems were randomized in 2018 and patient-level data was collected from 2 years before to 2 years after randomization. The primary outcome was any OUD medication treatment (i.e., buprenorphine or extended-release injectable naltrexone) during the post-randomization period for youth ages 16-25 years.
RESULTS: A total of 20,253 youth ages 16-25 years were seen in intervention and 26,562 in usual care clinics during the study period. Comparing patients by clinic arm, we did not detect a statistically significant difference in the odds of receiving OUD medication treatment after randomization (odds ratio 1.75, 95% CI 0.63-4.89). Among the small number of patients (n=67) who received OUD medication after randomization, median treatment days were 81.5 days (IQR 30-177) and 64 days (IQR 24-206) in intervention or usual care clinics, respectively.
CONCLUSIONS: We did not find evidence that implementing a primary care nurse care management model meaningfully increased OUD medication treatment among youth. In this special population, youth-centered approaches may be needed to promote prescribing and overcome known barriers to care, such as provider and patient hesitancy to use OUD medications.
METHODS: 12 primary care clinics from 6 health systems were randomized in 2018 and patient-level data was collected from 2 years before to 2 years after randomization. The primary outcome was any OUD medication treatment (i.e., buprenorphine or extended-release injectable naltrexone) during the post-randomization period for youth ages 16-25 years.
RESULTS: A total of 20,253 youth ages 16-25 years were seen in intervention and 26,562 in usual care clinics during the study period. Comparing patients by clinic arm, we did not detect a statistically significant difference in the odds of receiving OUD medication treatment after randomization (odds ratio 1.75, 95% CI 0.63-4.89). Among the small number of patients (n=67) who received OUD medication after randomization, median treatment days were 81.5 days (IQR 30-177) and 64 days (IQR 24-206) in intervention or usual care clinics, respectively.
CONCLUSIONS: We did not find evidence that implementing a primary care nurse care management model meaningfully increased OUD medication treatment among youth. In this special population, youth-centered approaches may be needed to promote prescribing and overcome known barriers to care, such as provider and patient hesitancy to use OUD medications.