Receipt of medications for opioid use disorders among veterans by race/ethnicity and legal involvement: an observational study of electronic health records

Background The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have...

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Vydáno v:Health & justice Ročník 13; číslo 1; s. 28 - 10
Hlavní autoři: Finlay, Andrea K., Pivovarova, Ekaterina, Yu, Mengfei, Timko, Christine, Binswanger, Ingrid A., Smelson, David, Taylor, Emmeline, Harris, Alex H. S.
Médium: Journal Article
Jazyk:angličtina
Vydáno: Berlin/Heidelberg Springer Berlin Heidelberg 29.04.2025
Springer Nature B.V
BMC
Témata:
Access
American Indians
Buprenorphine
Community and Environmental Psychology
Computerized medical records
Confidence
Confidence intervals
Criminology and Criminal Justice
Disorders
Drugs
Ethnicity
Health
Health records
Health services
Hispanic Americans
Hospital administration
Indigenous peoples
Law and Criminolgy
Legal status
Management
Medical records
Methadone
Military hospitals
Naltrexone
Narcotics
Observational studies
Opioid-related disorders
Opioids
Participation
Patients
Public Health
Quality improvement
Quality management
Race
Race relations
Regression analysis
Social Policy
Substance use disorder
United States Department of Veterans Affairs
Veterans
United States Department of Veterans Affairs
Methadone
Buprenorphine
Naltrexone
Opioid-related disorders
ISSN:2194-7899, 2194-7899
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Shrnutí:Background The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have multiplicative rather than additive effects. This study aimed to determine whether race/ethnicity and legal involvement interact in receipt of medications for opioid use disorder among Veterans Health Administration patients. Methods Using national electronic health record data from Fiscal Years 2021–2022, we examined the receipt of medications for opioid use disorder among veterans diagnosed with opioid use disorder who received healthcare at Veterans Health Administration facilities ( n  = 65,883). We conducted a mixed effects multivariable logistic regression model to examine an interaction effect of race/ethnicity and legal involvement with receipt of any medications for opioid use disorder, both unadjusted and adjusted for patient and facility characteristics. Results In an adjusted logistic regression model, the interaction effect indicated that non-Hispanic Black veterans with legal involvement had the lowest odds of medications for opioid use disorder receipt compared to non-Hispanic White veterans without legal involvement (adjusted odds ratio = 0.67, 95% confidence interval = 0.59–0.77, p  <.0001). Non-Hispanic American Indian/Alaska Native patients without legal involvement (adjusted odds ratio = 0.85, 95% confidence interval = 0.73–0.99, p  =.04) also had lower odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement. Non-Hispanic White veterans with legal involvement (adjusted odds ratio = 1.07, 95% confidence interval = 1.01–1.14, p  =.03) had higher odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement. Conclusions Veterans Health Administration quality improvement efforts should monitor interacting racial and legal status factors and understand and address patient, clinical, and regulatory barriers to medications for opioid use disorder among Black veterans with legal involvement.
Bibliografie:ObjectType-Article-1
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ISSN:2194-7899
2194-7899
DOI:10.1186/s40352-025-00336-6