Access to treatment for alcohol use disorders following Oregon's health care reforms and Medicaid expansion

McCarty, Dennis; Gu, Yifan; Renfro, Stephanie; Baker, Robin; Lind, Bonnie K.; McConnell, K. John

doi:10.1016/j.jsat.2018.08.002

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…A handful of studies have examined receipt of medications for the treatment of alcohol or opioid use disorder using Medicaid or commercial claims data. A recent study using data from the Oregon Medicaid program found that the percentage of patients with an alcohol use disorder diagnosis receiving a medication increased from 2.3% in 2010 to 3.8% in 2015 [104]. Similar data from the Oregon Medicaid program showed that the percentage of enrollees with an opioid use disorder diagnosis who received a medication did not significantly change from 2010 to 2016.…”

Section: Medicaid and Commercial Claims Datamentioning

confidence: 95%

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

et al. 2020

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Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.

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Section: Medicaid and Commercial Claims Datamentioning

confidence: 95%

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

et al. 2020

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“…The finding that Medicaid insurance was associated with significantly decreased AUD treatment was concerning and may be due to several interrelated factors. Overall, Medicaid insurance expansion has led to increased access to AUD treatment [23,24]. However, Medicaid enrollees often have restricted access to providers and specialty services compared to those with private insurance [25,26].…”

Section: Discussionmentioning

confidence: 99%

Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis

et al. 2023

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Background Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between medical conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. Methods This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Multivariable models were used to assess the factors associated with subsequent AUD treatment and 5-year mortality. Results Among 436 patients with cirrhosis due to alcohol, 65 patients (15%) received AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (2%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after a baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. Thirty percent of patients had hepatology-documented AUD treatment recommendations and 26% had primary care-documented AUD treatment recommendations. Most hepatology (86%) and primary care (88%) recommendations discussed behavioral therapy alone. Among patients with ongoing alcohol use at baseline, AUD treatment one year later was significantly, independently associated with AUD treatment discussions with hepatology (adjusted odds ratio (aOR): 3.23, 95% confidence interval (CI): 1.58, 6.89) or primary care (aOR: 2.95; 95% CI: 1.44, 6.15) and negatively associated with having Medicaid insurance (aOR: 0.43, 95% CI: 0.18, 0.93). When treatment was discussed in both settings, high rates of treatment ensued (aOR: 10.72, 95% CI: 3.89, 33.52). Over a 5-year follow-up period, 152 (35%) patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma were significantly associated with mortality in the final survival model. Conclusion AUD treatment discussions were documented in less than half of hepatology and primary care encounters in patients with alcohol-related cirrhosis, though such discussions were significantly associated with receipt of AUD treatment.

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“…Recommendations from the OPTIONS-DC, implemented in February 2018, resulted in significantly higher use of dalbavancin for treatment or completion of treatment at 27.4% compared to those with substance use disorder (SUD) who did not have an OPTIONS-DC (9%). 16 This highlights that successful coordination of dalbavancin courses begins prior to hospital discharge, and requires comprehensive planning, because patients may be unreachable once they leave.…”

Section: Discussionmentioning

confidence: 99%

The hidden cost of dalbavancin: OPAT RN time required in coordination for persons who use drugs

Douglass

Mayer

Young

et al. 2023

Therapeutic Advances in Infection

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Background: Serious infections in persons who use drugs (PWUD) are rising. Dalbavancin, due to its extended half-life, offers an alternative treatment for patients in whom standard of care antibiotics are not feasible or practical, allowing for reduced hospital days and the avoidance of central line placement or the use of complex oral regimens. Objectives: We aim to describe the time and effort required for coordination of dalbavancin courses by outpatient registered nurses (RNs) and other outpatient parenteral antimicrobial therapy (OPAT) staff. Design and methods: We conducted a retrospective review of adult patients with documented substance use who received at least one dose of dalbavancin and quantified the number of interventions required by our OPAT RNs and other OPAT staff for coordination of dalbavancin courses. Additionally, detailed data on time spent per intervention were prospectively collected for a 1-month period. Results: A total of 52 patients with 53 dalbavancin courses were included. Most substance use was intravenous. Infectious diagnoses included bone and joint infections (61%) and endocarditis (7%), in addition to skin and soft tissue infections (19%). Infections were most commonly caused by Staphylococcus aureus (62%). RN intervention was required in the coordination of 60% of all courses and in 77% of courses in which at least one outpatient dose was needed. Adverse reactions occurred in one patient (2%) and 90-day readmissions due to infectious complications occurred in two patients (4%). Detailed time analysis was performed for seven consecutive patients, with a total of 179 min spent by OPAT RNs on coordination. Conclusions: The ease of dalbavancin administration does not eliminate the need for extensive RN coordination for successful administration of doses in the outpatient setting for PWUD. This need should be accounted for in program staffing to help increase successful dalbavancin course completion.

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Access to treatment for alcohol use disorders following Oregon's health care reforms and Medicaid expansion

Cited by 11 publications

References 22 publications

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis

The hidden cost of dalbavancin: OPAT RN time required in coordination for persons who use drugs

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