BACKGROUND Studies assessing the comparative effectiveness of methadone versus buprenorphine/naloxone for opioid use disorder in real-world settings are rare - challenged by structural differences in delivery across settings and factors influencing treatment selection. We identified determinants of selection into buprenorphine/naloxone and quantified contributions of individual and provider-level covariates in a setting delivering both medications within the same healthcare settings. METHODS Utilizing linked health administrative datasets, we conducted a retrospective cohort study of people with opioid use disorder (PWOUD) receiving opioid agonist treatment (OAT) in British Columbia, Canada, from 2008-2017. Determinants of buprenorphine/naloxone selection were identified using a generalized linear mixed model with random intercept terms for providers and individuals. We determined the influence of individual demographics, clinical history, measures of provider experience and preference, and dates of key policy changes. RESULTS A total of 39,605 individuals experienced 178,976 OAT episodes (methadone:139,439(77.9 %);buprenorphine/naloxone:39,537(22.1 %)). Male sex, less OAT experience, younger age, mental health conditions and chronic pain were associated with higher odds of buprenorphine/naloxone prescription. For providers, higher client-attachment, more complex OAT case-mixes, and higher buprenorphine/naloxone prescribing-preference were also associated with higher odds of buprenorphine/naloxone prescription. Observed individual-level covariates explained 9.7 % of variance in odds of buprenorphine/naloxone selection, while observed provider-level covariates explained 20.0 %. Controlling for covariates, residual unmeasured between-individual variance accounted for 18.5 % of the explained variation in the odds of buprenorphine/naloxone selection, while unmeasured between-provider variance accounted for 28.4 %. CONCLUSION Provider characteristics were more influential in selection of buprenorphine/naloxone over methadone informing subsequent analyses of comparative effectiveness of these regimens.

中文翻译：

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在不列颠哥伦比亚省启动阿片类激动剂治疗的人群中选择丁丙诺啡/纳洛酮的决定因素。

背景技术评估美沙酮与丁丙诺啡/纳洛酮在现实环境中对阿片类药物使用障碍的比较有效性的研究很少，因为各种环境中的递送结构差异和影响治疗选择的因素都对这一挑战提出了挑战。我们确定了在丁丙诺啡/纳洛酮中选择的决定因素，并确定了在同一医疗机构中同时提供两种药物的环境中个体和提供者水平协变量的定量贡献。方法利用链接的卫生行政数据集，我们对2008年至2017年在加拿大不列颠哥伦比亚省接受阿片类药物激动剂治疗（OAT）的阿片类药物使用障碍（PWOUD）的患者进行了回顾性队列研究。丁丙诺啡/纳洛酮选择的决定因素是使用具有提供者和个人随机拦截条件的广义线性混合模型确定的。我们确定了个人人口统计学的影响，临床病史，提供者经验和偏爱的衡量标准以及关键政策变更的日期。结果共有39,605人经历了178,976次OAT发作（美沙酮：139,439（77.9％）；丁丙诺啡/纳洛酮：39,537（22.1％））。男性，较少的OAT经历，年龄较小，心理健康状况和慢性疼痛与丁丙诺啡/纳洛酮处方的几率较高相关。对于提供者来说，较高的客户依恋度，更复杂的OAT案例组合以及较高的丁丙诺啡/纳洛酮处方偏好也与丁丙诺啡/纳洛酮处方的较高机率相关。观察到的个体水平协变量解释了9.7％的丁丙诺啡/纳洛酮选择方差，而观察到的提供者水平协变量解释了20.0％。控制协变量，剩余的未测量个体间差异占丁丙诺啡/纳洛酮选择机率的解释差异的18.5％，而未测量提供者间差异占28.4％。结论提供者的特征在选择丁丙诺啡/纳洛酮方面比美沙酮更具影响力，这意味着随后对这些方案的比较有效性进行了分析。丁丙诺啡/纳洛酮选择的解释可能性的5％为解释性变化，而供应商之间未测量的差异为28.4％。结论提供者的特征在选择丁丙诺啡/纳洛酮方面比美沙酮更具影响力，这意味着随后对这些方案的比较有效性进行了分析。丁丙诺啡/纳洛酮选择的解释可能性的5％为解释性变化，而供应商之间未测量的差异为28.4％。结论提供者的特征在选择丁丙诺啡/纳洛酮方面比美沙酮更具影响力，这意味着随后对这些方案的比较有效性进行了分析。