@article {4417,
	title = {Buprenorphine Maintenance Treatment Retention Improves Nationally Recommended Preventive Primary Care Screenings when Integrated into Urban Federally Qualified Health Centers.},
	journal = {Journal of urban health : bulletin of the New York Academy of Medicine},
	year = {2014},
	month = {2014 Dec 31},
	abstract = {Buprenorphine maintenance therapy (BMT) expands treatment access for opioid dependence and can be integrated into primary health-care settings. Treating opioid dependence, however, should ideally improve other aspects of overall health, including preventive services. Therefore, we examined how BMT affects preventive health-care outcomes, specifically nine nationally recommended primary care quality health-care indicators (QHIs), within federally qualified health centers (FQHCs) from an observational cohort study of 266 opioid-dependent patients initiating BMT between 07/01/07 and 11/30/08 within Connecticut{\textquoteright}s largest FQHC network. Nine nationally recommended preventive QHIs were collected longitudinally from electronic health records, including screening for chronic infections, metabolic conditions, and cancer. A composite QHI score (QHI-S), based on the percentage of eligible QHIs achieved, was categorized as QHI-S >=80~\% (recommended) and >=90~\% (optimal). The proportion of subjects achieving a composite QHI-S >=80 and >=90~\% was 57.1 and 28.6~\%, respectively. Screening was highest for hypertension (91.0~\%), hepatitis C (80.1~\%), hepatitis B (76.3~\%), human immunodeficiency virus (71.4~\%), and hyperlipidemia (72.9~\%) and lower for syphilis (49.3~\%) and cervical (58.5~\%), breast (44.4~\%), and colorectal (48.7~\%) cancer. Achieving QHI-S >=80~\% was positively and independently associated with >=3-month BMT retention (adjusted odds ratio (AOR) = 2.19; 95~\% confidence interval (CI) = 1.18-4.04) and BMT prescription by primary care providers (PCPs) rather than addiction psychiatric specialists (AOR = 3.38; 95~\% CI = 1.78-6.37), and negatively with being female (AOR = 0.30; 95~\% CI = 0.16-0.55). Within primary health-care settings, achieving greater nationally recommended health-care screenings or QHIs was associated with being able to successfully retain patients on buprenorphine longer (3~months or more) and when buprenorphine was prescribed simultaneously by PCPs rather than psychiatric specialists. Decreased preventive screening for opioid-dependent women, however, may require gender-based strategies for achieving health-care parity. When patients can be retained, integrating BMT into urban FQHCs is associated with improved health outcomes including increased multiple preventive health-care screenings.},
	issn = {1468-2869},
	doi = {10.1007/s11524-014-9924-1},
	author = {Haddad, Marwan S and Zelenev, Alexei and Altice, Frederick L}
}
