National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
126 to 150 of 699 Research Studies DisplayedCross WF, West JC, Crean HF
Measurement of primary care providers' suicide prevention skills following didactic education.
This study’s objective was to determine if didactic training by medical residents and nurse practitioner (NP) trainees increased their skills to assess and manage patients’ suicidal ideation, intent, and behaviors. Online didactic training was provided to 127 medical resident and NP trainees followed by a standardized patient interaction conducted to assess demonstrated suicide prevention skills (i.e., assessment of risk factors, protective factors, suicidal ideation and behavior, safety planning). Participants demonstrated only about half of the possible total skills in most domains and were least competent in assessing potential risk for suicide. Residents were rated significantly higher than NPs on observed skills.
AHRQ-funded; HS024224.
Citation: Cross WF, West JC, Crean HF .
Measurement of primary care providers' suicide prevention skills following didactic education.
Suicide Life Threat Behav 2022 Jun;52(3):373-82. doi: 10.1111/sltb.12827..
Keywords: Behavioral Health, Primary Care, Prevention, Education: Continuing Medical Education, Provider: Physician, Training
Meiselbach MK, Drake C, Saloner B
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
This study examined variation in access to in-network buprenorphine-prescribing primary care providers that can treat opioid use disorder among Medicaid managed care enrollees. Approximately 32.2% of Medicaid enrollees had fewer than one in-network network buprenorphine-prescribing primary care providers per 100,000 county residents. There was on average a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates, but most enrollees lived in areas with a shortage of these providers. The authors found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Drake C, Saloner B .
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
Health Aff 2022 Jun;41(6):901-10. doi: 10.1377/hlthaff.2021.01719..
Keywords: Medicaid, Primary Care, Access to Care, Medication, Care Management, Opioids, Substance Abuse, Behavioral Health
Petts RA, Walker BL, Hails KA
Parents' preferences for behavioral services in primary care during the COVID-19 pandemic.
The purpose of the study was to evaluate whether the COVID-19 pandemic impacted parent’s preferences and priorities for receiving behavioral health services for their young children in the pediatric primary care setting. In 5 pediatric primary care sites across the U.S., between July 2020 and January 2021, 301 parents of young children completed surveys on their preferences for behavioral subjects and methods of service delivery in primary care. The responses were compared to the responses from 396 parents who had been surveyed on the same measures in 2018. The study concluded that priorities for behavioral subjects during the pandemic were similar to parent’s priorities before the pandemic, with only one behavioral subject (child self-calming) rated significantly more important by the parents in the pandemic group than the pre-pandemic parents. The parents in the pandemic group were also significantly more interested in remote and media-based services such as mobile applications and videos than parents in the pre-pandemic group. The researchers conclude that pediatric primary care practices may wish to consider providing mobile apps, videos, and/ or other multimedia resources as part of their behavioral health services practices.
AHRQ-funded; HS022981.
Citation: Petts RA, Walker BL, Hails KA .
Parents' preferences for behavioral services in primary care during the COVID-19 pandemic.
J Dev Behav Pediatr 2022 Jun-Jul;43(5):291-96. doi: 10.1097/dbp.0000000000001033..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Primary Care
King C, Goldstein E, Crits-Christoph P
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
The purpose of this study was to: examine the comorbidities of mental health issues and a medical condition in a community mental health setting with a primarily Medicare and Medicaid population; describe the range of comorbid medical conditions in this setting; and explore the association between medical conditions on the alliance, attrition from services and outcome. The researchers accessed patient charts and conducted structured clinical interviews to collect medical diagnoses from 353 participants who had previously had a baseline evaluation as a participant in a study of therapies for major depressive disorder. The researchers reported that a high percentage of patients in the study experienced a comorbid medical condition. There were no significant correlations between the number of medical conditions and treatment outcome or early attrition from treatment. Further analyses revealed that the presence of a nervous system disorder was correlated with poorer treatment outcomes. The researchers concluded that patients undergoing treatment for major depressive disorder may benefit from simultaneously attending to the impact of medical conditions on physical functioning.
AHRQ-funded; HS018440.
Citation: King C, Goldstein E, Crits-Christoph P .
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
Psychotherapy 2022 Jun;59(2):199-208. doi: 10.1037/pst0000380..
Keywords: Depression, Behavioral Health, Community-Based Practice
Choi KR, Lotfizadah AD, Bhakta B
Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism.
In clinical trials, applied behavioral analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown to improve child functional status. Setting and tracking individualized, patient-centered goals is a focus in ABA, yet there is little research on measuring progress on such goals. The purpose of this study was to observe and evaluate a clinical sample of children 3 to 16 years of age (N=154) receiving 24 months of ABA for autism spectrum disorder, and assess the concordance between patient-centered and standard outcome measures of treatment progress. The study found that there was limited concordance among measures at 12 and 24 months of ABA. The study also found that between 12 and 24 months of ABA, the percentage of children who achieved clinically meaningful gain on patient-centered goal measures increased, while the percentage of children who achieved clinically meaningful gains in adaptive behavior decreased. The study concluded that providers should have continuous dialogue with patients and caregivers to ensure that ASD programs and interventions progress toward meaningful goals and outcomes for patients and their caregivers.
AHRQ-funded; HS026407.
Citation: Choi KR, Lotfizadah AD, Bhakta B .
Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism.
BMC Pediatr 2022 May 27;22(1):314. doi: 10.1186/s12887-022-03383-2..
Keywords: Patient-Centered Healthcare, Autism, Behavioral Health
Bunting AM, Dickson M, Staton M
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
The purpose of this study was to: 1) identify the patterns of polysubstance use of rural Appalachian justice-involved women, 2) examine how women's participation in polysubstance use changed in the 12-months after initial release from jail, and 3) determine if changes in women's substance use patterns were correlated with re-incarceration during the 12-months of follow-up after release. The researchers randomly recruited 339 women with a recent history of substance use from three rural jails, and analyzed their substance use from baseline (in jail) to 6 and 12-months. The study found three latent classes: High Polysubstance/injection drug use (IDU) (36.3% baseline), Opioid/Benzo (Benzodiazepine) Involved Polysubstance Use (57.3% baseline), and Low Use (6.4% baseline). After release, and especially in the first 6 months, women transitioned to latent classes of reduced substance use and/or reduced injection drug use. Women who were re-incarcerated during follow-up were likely to remain engaged in, or transition to, the High Polysubstance/IDU class. The researchers concluded that a crucial period for changes in substance use lies in the six-months post-release.
AHRQ-funded; HS026120.
Citation: Bunting AM, Dickson M, Staton M .
Polysubstance use and re-incarceration in the 12-months after release from jail: a latent transition analysis of rural Appalachian women.
Am J Drug Alcohol Abuse 2022 May 4;48(3):356-66. doi: 10.1080/00952990.2021.1995402..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Women
Luckenbaugh AN, Wallis CJD, Huang LC
Association between treatment for localized prostate cancer and mental health outcomes.
Researchers conducted a prospective population-based analysis using the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study to compare mental health outcomes for men undergoing treatment for localized prostate cancer. Results showed that there were no clinically important differences in mental health outcomes; however, the researchers identified a number of characteristics associated with worse mental health outcomes. These included: older age, poorer health, and being unmarried.
AHRQ-funded; HS019356; HS022640.
Citation: Luckenbaugh AN, Wallis CJD, Huang LC .
Association between treatment for localized prostate cancer and mental health outcomes.
J Urol 2022 May; 207(5):1029-37. doi: 10.1097/ju.0000000000002370..
Keywords: Cancer: Prostate Cancer, Cancer, Behavioral Health, Quality of Life
Mitchell SE, Reichert M, Howard JM
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
The purpose of this randomized controlled trial study was to assess whether post-discharge depression treatment will benefit hospitalized patients by reducing readmissions. Participants included hospitalized patients with a patient health questionnaire-9 score of 10 or higher. The researchers delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention. The study found that at 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission or reutilization. The intention-to-treat analysis also showed no differences at 90 days in readmission or reutilization. In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions. The study concluded that unplanned hospital use can be decreased with post-discharge treatment of depression and support for care transition.
AHRQ-funded; HS019700.
Citation: Mitchell SE, Reichert M, Howard JM .
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
Ann Fam Med 2022 May-Jun;20(3):246-54. doi: 10.1370/afm.2801..
Keywords: Depression, Behavioral Health, Hospital Readmissions, Hospital Discharge, Transitions of Care
Khodneva Y, Goyal P, Levitan EB
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
The purpose of this study was to determine whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). The study found that over a median of 9.2 years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 for participants with depressive symptoms compared with 3.2 for participants without depressive symptoms. For overall HF, the elevated risk lessened after controlling for covariates. Among those without baseline CHD, when HFpEF was evaluated separately, after controlling for all covariates, depressive symptoms were related with incident hospitalization. In contrast, depressive symptoms were not related with incident HFrEF hospitalizations. The researchers concluded that among individuals without CHD at baseline, depressive symptoms were related with incident hospitalization for HFpEF, but not for those with baseline CHD or HFrEF.
AHRQ-funded; HS013852.
Citation: Khodneva Y, Goyal P, Levitan EB .
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
J Am Heart Assoc 2022 Apr 5;11(7):e022818. doi: 10.1161/jaha.121.022818..
Keywords: Depression, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk
Riley AR, Walker BL, Ramanujam K
A mixed-method investigation of parent perspectives on early childhood behavioral services in primary care.
This study used a sequential-explanatory mixed-method design to understand factors underlying parents' attitudes toward the content, sources, and delivery methods of behavioral guidance in primary care. Findings showed that parents emphasized a need for tailored behavioral guidance; multiple interconnected factors drove parents' attitudes toward behavioral primary care. Further, these attitudes varied based on socioeconomic status, child behavior symptoms, and reported use of corporal punishment.
AHRQ-funded; HS022981.
Citation: Riley AR, Walker BL, Ramanujam K .
A mixed-method investigation of parent perspectives on early childhood behavioral services in primary care.
J Behav Health Serv Res 2022 Apr;49(2):134-48. doi: 10.1007/s11414-021-09772-2..
Keywords: Children/Adolescents, Primary Care, Behavioral Health
McBain RK, Cantor JH, Kofner A
Brief report: Medicaid expansion and growth in the workforce for autism spectrum disorder.
This study examined the role that state Medicaid expansion has played in utilization of child psychiatrists, board-certified behavioral analysts (BCBAs) and pediatricians for children with autism spectrum disorder (ASD). Health workforce data from HRSA was used to examine workforce growth from 2008-2017. State Medicaid expansion was associated with a 9% increase in BCBAs per 100,000 children one year after enactment, and a 5% increase in child psychiatrists, but no association with growth in pediatrician utilization.
AHRQ-funded; HS025750.
Citation: McBain RK, Cantor JH, Kofner A .
Brief report: Medicaid expansion and growth in the workforce for autism spectrum disorder.
J Autism Dev Disord 2022 Apr;52(4):1881-89. doi: 10.1007/s10803-021-05044-2..
Keywords: Children/Adolescents, Autism, Medicaid, Workforce, Behavioral Health
Parast L, Burkhart Q, Bardach NS
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
The authors sought to develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. Using Medicaid administrative data, they concluded that this new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, they recommended future work in order to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
AHRQ-funded; HS025291.
Citation: Parast L, Burkhart Q, Bardach NS .
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
Acad Pediatr 2022 Apr;22(3s):S92-s99. doi: 10.1016/j.acap.2021.03.005..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Measures, Quality Indicators (QIs), Quality of Care
Lin Y, Sharma B, Thompson HM
External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients.
This study’s objective was to validate a machine learning approach to alcohol screening using a natural language processing (NLP) classifier developed at an independent medical center. This retrospective cohort study took place at a midwestern US tertiary-care, urban medical center that has an inpatient structured universal screening model for unhealthy substance use and an active addiction consult service. The cohort included 57,605 unplanned admissions of adult patients between October 23, 2017 and December 31, 2019 with electronic health record (EHR) documentation of manual alcohol screening. The authors examined error in manual screening and reviewed discordance between the NLP classifier and AUDIT-derived reference. The classifier demonstrated adequate sensitivity and specificity for routine clinical use as an automated screening tool for identifying at-risk patients.
AHRQ-funded; HS026385.
Citation: Lin Y, Sharma B, Thompson HM .
External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients.
Addiction 2022 Apr;117(4):925-33. doi: 10.1111/add.15730..
Keywords: Alcohol Use, Behavioral Health, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Morden E, Byron S, Roth L
Health plans struggle to report on depression quality measures that require clinical data.
This study examined challenges and opportunities for reporting 5 HEDIS measures which used electronic clinical data to assess adolescent and perinatal depression care quality. Two learning collaboratives were convened with 10 health plans from 5 states. The authors conducted analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. The challenges most reported included: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices.
AHRQ-funded; HS025296.
Citation: Morden E, Byron S, Roth L .
Health plans struggle to report on depression quality measures that require clinical data.
Acad Pediatr 2022 Apr;22(3s):S133-s39. doi: 10.1016/j.acap.2021.09.022..
Keywords: Children/Adolescents, Depression, Behavioral Health, Quality Indicators (QIs), Quality Measures, Quality of Care
Crockett KB, Borgatti A, Tan F
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
This study examined the role that weight discrimination and race is associated with pre-treatment depressive symptoms. A cohort of Black and White adults were enrolled in a 16-week obesity intervention treatment (N = 271; mean BMI = 35.7 kg/m2); 59% Black; 92% women). They reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Their weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. Participants with a history of weight discrimination scored 2.4 points higher on the CES-D and lost 2% less weight relative to those without weight discrimination. Race modified the association between weight discrimination and treatment session attendance, such that Black participants attended fewer sessions if they had prior experience of weight discrimination. However, this association was not true among White individuals.
AHRQ-funded; HS013852.
Citation: Crockett KB, Borgatti A, Tan F .
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
Int J Behav Med 2022 Apr;29(2):152-59. doi: 10.1007/s12529-021-10009-x..
Keywords: Obesity, Obesity: Weight Management, Behavioral Health, Racial and Ethnic Minorities, Depression
Scott K, Becker SJ, Helseth SA
Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.
This systematic literature review examined the impact of pharmacotherapy interventions on adolescents with substance use (SU) disorders and mental health issues. The authors included ten randomized controlled trials exploring seven pharmacotherapies in the final evaluation. All studies had low to moderate risk of bias. Four studies evaluated pharmacotherapy for co-occurring depression and SU, 3 evaluated ADHD and SU, and 3 evaluated bipolar disorder and SU. Five of the 10 studies included a behavioral intervention. They found no evidence that pharmacotherapy for co-occurring mental health diagnoses impacted SU.
AHRQ-funded; 290201500002I.
Citation: Scott K, Becker SJ, Helseth SA .
Pharmacotherapy interventions for adolescent co-occurring substance use and mental health disorders: a systematic review.
Fam Pract 2022 Mar 24;39(2):301-10. doi: 10.1093/fampra/cmab096..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health, Medication
Tang LA, Jeffery AD, Leech AA
A comparison of methods to identify antenatal substance use within electronic health records.
This study described the development of a natural-language-processing-based algorithm for detecting antenatal substance use among individuals receiving perinatal care. Findings showed that the accuracy of antenatal substance use detection was improved with more stringent case definitions; however, the overall proportion of true cases confirmed by manual chart review decreased.
AHRQ-funded; HS026395.
Citation: Tang LA, Jeffery AD, Leech AA .
A comparison of methods to identify antenatal substance use within electronic health records.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100535. doi: 10.1016/j.ajogmf.2021.100535..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Pregnancy, Women, Behavioral Health
Sivaraman JC, Greene SB, Naumann RB
Association between medical diagnoses and suicide in a Medicaid beneficiary population, North Carolina 2014-2017.
This study investigated the impact of various medical diagnoses on firearm and nonfirearm suicide. The authors used a case-control design including 691 North Carolina Medicaid beneficiaries who died from suicide between 2014 and 2017 as cases. They selected 68,682 controls. They linked Medicaid claims to the North Carolina Violent Death Reporting System to ascertain suicide and means (firearm or nonfirearm). They matched cases and controls on number of months covered by Medicaid over the past 36 months They adjusted for sex, race, Supplemental Security Income state, the Charlson Comorbidity Index, and frequency of health care encounters. The case-control odds ratios for any mental health disorder were 4.2 for nonfirearm suicide and 2.2 for firearm suicide. Behavioral health diagnoses were more strongly associated with nonfirearm suicides than firearm suicides in men but not in women. There was a weaker association of mental health and substance use diagnoses with suicides in Blacks, although estimates were imprecise.
AHRQ-funded; HS000032.
Citation: Sivaraman JC, Greene SB, Naumann RB .
Association between medical diagnoses and suicide in a Medicaid beneficiary population, North Carolina 2014-2017.
Epidemiology 2022 Mar 1; 33(2):237-45. doi: 10.1097/ede.0000000000001439..
Keywords: Behavioral Health, Medicaid
Presskreischer R, Steinglass JE, Anderson KE
Eating disorders in the U.S. Medicare population.
This cross-sectional study explored the prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. A representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records was used. The sample included almost 12 million Medicare enrollees of whom 0.15% had an eating disorder diagnosis. A greater proportion of individuals diagnosed with an eating disorder diagnosis were female, under age 65, and dually eligible for Medicaid due to disability or low-income qualification than those without a diagnosis. Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias, arthritis, and thyroid conditions. Spending was $29,456 for enrollees with eating disorders compared to $7,418 without.
AHRQ-funded; HS000029.
Citation: Presskreischer R, Steinglass JE, Anderson KE .
Eating disorders in the U.S. Medicare population.
Int J Eat Disord 2022 Mar;55(3):362-71. doi: 10.1002/eat.23676..
Keywords: Behavioral Health, Medicare, Healthcare Costs
Auty SG, Griffith KN
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. Using data from the CDC’s WONDER database, findings showed that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
AHRQ-funded; HS026395.
Citation: Auty SG, Griffith KN .
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
Drug Alcohol Depend 2022 Mar 1;232:109340. doi: 10.1016/j.drugalcdep.2022.109340..
Keywords: COVID-19, Medicaid, Opioids, Substance Abuse, Behavioral Health, Mortality, Public Health
Cochran G, Cole ES, Sharbaugh M
Provider and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder.
This study examined primary care provider (PCP) and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder (MOUD). The authors assessed a retrospective cohort from 2015 to 2018 within the Pennsylvania Medicaid Program. Participants included PCPs who were Medicaid providers, with no history of MOUD provision, and who treated 10 or more Medicaid enrollees annually. The authors identified 113 rural and 782 urban PCPs who engaged in initial adoption and 36 rural and 288 urban PCPs who engaged in sustained prescribing. Rural/urban PCPs who prescribed increasing larger numbers of antidepressant and antipsychotic medications had greater odds of initial adoption and sustained prescribing compared to those that did not prescribe these medications. Each additional patient out of 100 with opioid use disorder diagnosed before MOUD adoption increased the adjusted odds for initial adoption 2% to 4% and sustained prescribing by 4% to 7%. New Medicaid providers in rural areas were 2.52 and in urban areas were 2.66 more likely to engage in initial MOUD adoption compared to established PCPs.
AHRQ-funded; HS025072.
Citation: Cochran G, Cole ES, Sharbaugh M .
Provider and patient-panel characteristics associated with initial adoption and sustained prescribing of medication for opioid use disorder.
J Addict Med 2022 Mar-Apr;16(2):e87-e96. doi: 10.1097/adm.0000000000000859..
Keywords: Opioids, Medication, Substance Abuse, Patient Adherence/Compliance, Behavioral Health
Gertner AK, Rotter JS, Holly ME
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
This observational study’s goal was to determine if individuals newly diagnosed with opioid use disorder (OUD) who saw a primary care provider (PCP) before or on the date of diagnosis had higher rates of medication treatment for OUD (MOUD). Claims data from Medicaid and a large private insurer in North Carolina from January 2014 to July 2017 was used. During the period from 2014 to 2017, the prevalence of diagnosed OUD increased by 47% among Medicaid enrollees and by 76% among the privately insured. Over the same time period the number of people with an OUD who received MOUD fell among both groups, while PCP involvement in treatment increased. The percent of Medicaid enrollees receiving buprenorphine from a PCP increased from 32% in 2014 to 39% in 2017. In the 12 months before being newly diagnosed, approximately 82% with Medicaid or private insurance had a PCP visit. There was no difference in receiving an MOUD with those who had not seen a PCP. However, there was a higher probability of receiving MOUD with a PCP, than seeing an emergency provider, but lower than seeing a behavioral health specialist or other provider type.
AHRQ-funded; HS025065.
Citation: Gertner AK, Rotter JS, Holly ME .
The role of primary care in the initiation of opioid use disorder treatment in statewide public and private insurance.
J Addict Med 2022 Mar-Apr;16(2):183-91. doi: 10.1097/adm.0000000000000860..
Keywords: Primary Care, Opioids, Substance Abuse, Behavioral Health, Health Insurance
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
AHRQ-funded; HS027230.
Citation: Wei YJ, Chen C, Lewis MO .
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
Wyse JJ, McGinnis KA, Edelman EJ
Twelve-month retention in opioid agonist treatment for opioid use disorder among patients with and without HIV.
Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder (OUD). The investigators concluded that history of homelessness was associated with a lower likelihood of retention. Predictors of retention were largely distinct between patients with HIV and patients without HIV. Findings highlighted the need for clinical, systems, and research initiatives to better understand and improve OAT retention.
AHRQ-funded; HS026370.
Citation: Wyse JJ, McGinnis KA, Edelman EJ .
Twelve-month retention in opioid agonist treatment for opioid use disorder among patients with and without HIV.
AIDS Behav 2022 Mar;26(3):975-85. doi: 10.1007/s10461-021-03452-0..
Keywords: Opioids, Substance Abuse, Behavioral Health, Human Immunodeficiency Virus (HIV)
Holtrop JS, Mullen R, Curcija K
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
The purpose of this qualitative study was to investigate clinician and staff perceptions related to medication assisted treatment (MAT) for opioid use disorder, particularly buprenorphine treatment, in rural primary care practices. Staff members from rural 42 practices were interviewed. Although there was almost no provision of MAT, policies and procedures to reduce opioid prescribing were usually in place and many practices expressed interest in learning more to help their patients and local communities.
AHRQ-funded; HS025056.
Citation: Holtrop JS, Mullen R, Curcija K .
The balance between serving the community and the reality of treating opioid use disorder in rural primary care practices.
J Health Care Poor Underserved 2022; 33(1):253-67. doi: 10.1353/hpu.2022.0019..
Keywords: Opioids, Substance Abuse, Behavioral Health, Primary Care, Rural Health, Medication