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Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

Nguemeni Tiako, Max Jordan; Culhane, Jennifer; South, Eugenia; Srinivas, Sindhu K.; Meisel, Zachary F.

Any: 2020

This cross-sectional study examines the prevalence and geographic distribution within the US of obstetrician-gynecologists who are able to prescribe buprenorphine for women who are pregnant. Importance The incidence of opioid use during pregnancy is increasing, and drug overdoses are a leading cause of postpartum mortality. Most women who are pregnant do not receive medications for treatment of opioid use disorder, despite the mortality benefit that these agents confer. Furthermore, buprenorphine is associated with milder symptoms of neonatal abstinence syndrome (NAS) compared with methadone. Objective To describe the prevalence and geographic distribution across the US of obstetrician-gynecologists who can prescribe buprenorphine (henceforth described as X-waivered) in 2019. Design, Setting, and Participants A cross-sectional, nationwide study linking physician-specific data to county- and state-level data was conducted from September 1, 2019, to March 31, 2020. Data were obtained on 31 211 obstetrician-gynecologists who accept Medicaid insurance through the Centers for Medicare & Medicaid Services Physician Compare data set and linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list. Exposures State-level NAS incidence and county-level uninsured rates and rurality. Main Outcomes and Measures Prevalence and geographic distribution of obstetrician-gynecologists who are trained to prescribe buprenorphine. Results Among the 31 211 identified obstetrician-gynecologists, 18 710 (59.9%) were women. Most had hospital privileges (23 236 [74.4%]) and worked in metropolitan counties (28 613 [91.7%]). Only 560 of the identified obstetrician-gynecologists (1.8%) were X-waivered. Obstetrician-gynecologists in counties with fewer than 5% uninsured residents had nearly twice the odds of being X-waivered (adjusted odds ratio [aOR], 1.59; 95% CI, 1.04-2.44; P = .04) compared with those in counties with greater than 15% uninsured residents. Compared with those located in metropolitan counties, obstetrician-gynecologists in suburban counties (eg, urban population of >= 20 000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85; 95% CI, 1.26-2.71; P = .002). Compared with states with an NAS rate of 5 per 1000 births or less, obstetrician-gynecologists in states with an NAS rate of 15 per 1000 births or greater had nearly 5 times the odds of being X-waivered (aOR, 4.94; 95% CI, 3.60-6.77; P < .001). Obstetrician-gynecologists without hospital privileges were more likely to be X-waivered (aOR, 1.32; 95% CI, 1.08-1.61; P = .007). Conclusions and Relevance Fewer than 2% of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, and their geographic distribution appears to be skewed in favor of suburban counties. This finding suggests that there is an opportunity for health systems and professional societies to incentivize X-waiver trainings among obstetrician-gynecologists to increase patients´ access to buprenorphine, especially during pregnancy. Question What is the geographic distribution across the US and prevalence of Medicaid-claimant obstetrician-gynecologists who are trained to prescribe buprenorphine? Findings In this cross-sectional study including 31 211 Medicaid-claimant obstetrician-gynecologists, fewer than 2% were trained to prescribe buprenorphine. In addition, these physicians were more likely to work in primarily suburban counties. Meaning Results of this study suggest that an opportunity exists for obstetrician-gynecologists to contribute to expanding the workforce of clinicians who can prescribe buprenorphine to further address the opioid epidemic´s association with maternal and infant morbidity and mortality.

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Darrera actualització: 28/03/2024

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