Dual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans

Moyo, Patience; Zhao, Xinhua; Thorpe, Carolyn T.; Thorpe, Joshua M.; Sileanu, Florentina E.; Cashy, John; Hale, Jennifer; Mor, Maria K.; Radomski, Thomas R.; Donohue, Julie M.; Hausmann, Leslie R.M.; Hanlon, Joseph T.; Good, Chester B.; Fine, Michael J.; Gellad, Walid F.

doi:10.7326/m18-2574

Cited by 26 publications

(22 citation statements)

References 48 publications

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“…We assigned a pseudodiagnosis date for controls. This was done by matching controls to patients with cancer by age and sex and applying the cancer diagnosis date to matched controls . Going forward, this will be referred to this as the “index date” for controls.…”

Section: Methodsmentioning

confidence: 99%

“…Going forward, this will be referred to this as the “index date” for controls. Implementing this published approach allowed us to have the same distribution of index years in the cancer and noncancer groups …”

Section: Methodsmentioning

confidence: 99%

“…This was done by matching controls to patients with cancer by age and sex and applying the cancer diagnosis date to matched controls. 20 Going forward, this will be referred to this as the "index date" for controls. Implementing this published approach allowed us to have the same distribution of index years in the cancer and noncancer groups.…”

Section: Noncancer Cohortmentioning

confidence: 99%

“…Implementing this published approach allowed us to have the same distribution of index years in the cancer and noncancer groups. 20…”

Section: Noncancer Cohortmentioning

confidence: 99%

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Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Pinheiro

Soroka

Kern

et al. 2020

Cancer

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Background Diabetes places patients with cancer at an increased risk of infections, hospitalizations, and mortality. The objective of the current study was to characterize diabetes care management patterns among patients with cancer in the year before and, separately, after cancer diagnosis. The authors hypothesized that diabetes care declines after a diagnosis of cancer. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims data was used. The authors included diabetic beneficiaries aged ≥65 years who were diagnosed with incident, nonmetastatic breast, prostate, or colorectal cancer between 2008 and 2013. Controls were diabetic Medicare beneficiaries in SEER regions who did not have cancer. Cases were matched to controls based on age, sex, Charlson Comorbidity Index, and diabetes severity. Primary outcomes were diabetes care received over 12 months: 1) hemoglobin A1c testing; 2) eye examination; and 3) low‐density lipoprotein testing. Using a difference‐in‐difference (DID) approach, the authors examined use differences 12 months before to after diagnosis for patients with cancer and controls. To avoid capturing testing related to diagnosis and not diabetes management, the authors implemented a 90‐day washout period (45 days before and/or after diagnosis). Results A total of 32,728 diabetic patients with cancer and 32,728 matched noncancer controls were included. After diagnosis, patients with cancer were found to have modest, but significantly lower, rates of diabetes care use compared with controls. Patients with cancer had greater declines in hemoglobin A1c testing (DID, 2.4%; 95% CI, 1.7%‐3.0%), low‐density lipoprotein testing (DID, 4.3%; 95% CI, 3.6%‐5.0%), and receipt of all diabetes indicators (DID, 2.7%; 95% CI, 1.8%‐3.5%) 12 months before to after diagnosis. Conclusions Compared with controls, less diabetes care use was observed among patients with cancer in the year after diagnosis. Understanding and addressing the reasons for this may improve outcomes in this population.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Noncancer Cohortmentioning

confidence: 99%

“…Implementing this published approach allowed us to have the same distribution of index years in the cancer and noncancer groups. 20…”

Section: Noncancer Cohortmentioning

confidence: 99%

See 2 more Smart Citations

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Pinheiro

Soroka

Kern

et al. 2020

Cancer

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“…Furthermore, regarding the system structure, we note the dual drug benefit use among Veterans Affairs (VA) and Medicare Part D enrollees, where about 25% of VA enrollees who use opioids are reported to also obtain opioid prescription from dual sources [ 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers

et al. 2022

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ImportancePolicy makers have sought to discourage concurrent prescribing of opioids and benzodiazepines (coprescribing) because it is associated with overdose. Email alerts sent by pharmacists may reduce coprescribing, but this intervention lacks randomized evidence.ObjectiveTo investigate whether pharmacist emails to practitioners caring for patients who recently received opioids and benzodiazepines reduce coprescribing of these medications.Design, Setting, and ParticipantsRandomized clinical trial (intention to treat) conducted in 2019-2021 of patients and their practitioners (prescribers and primary care managers) in the National Capital Region of the Military Health System. Participants were 2237 patients who were recently coprescribed opioids and benzodiazepines. These patients had 789 practitioners eligible for emails.InterventionsPatients were randomized to email alerts to their practitioners or as-usual care. Clinical pharmacists sent the email alert. Messages were standardized and designed to facilitate coordination between practitioners, increase awareness of guidelines, and provide action steps and resources.Main Outcomes and MeasuresThe primary outcomes were patients’ days received of opioids, benzodiazepines, and concurrent opioids and benzodiazepines during the 90 days following enrollment evaluated using 1-sided hypothesis tests. Secondary outcomes included total prescribing of opioids and benzodiazepines by patients’ practitioners, including to patients outside the study, to test for broader outcomes on their prescribing.ResultsOf 2237 patients, 1187 were assigned to treatment and 1050 to control; 1275 (57%) were women. Patients received a mean (SD) of 31 (44) days of opioids and 33 (34) days of benzodiazepines in the 90 days before enrollment. There were no detected differences in the primary end points, including patients’ receipt of opioids (adjusted difference, 1.1 days; 95% CI, -∞ to 3.0; P = .81), benzodiazepines (adjusted difference, −0.6 days; 95% CI, -∞ to 1.4; P = .30), and opioids and benzodiazepines together (adjusted difference, −0.1 days; 95% CI, -∞ to 0.7; P = .41). Of 789 practitioners, 429 were considered the treatment group, 325 were considered controls, and 35 were excluded. There were no detected differences in practitioners’ total prescribing of opioids, benzodiazepines, or both drug classes together.Conclusions and RelevanceIn this randomized clinical trial of pharmacist emails to practitioners, email alerts failed to detectably reduce coprescribing, highlighting the value of alternative approaches. Combining randomization with quality improvement activities may help stakeholders seeking evidence-based interventions to encourage guideline-concordant care.Trial RegistrationClinicalTrials.gov Identifier: NCT03887247

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Dual Receipt of Prescription Opioids From the Department of Veterans Affairs and Medicare Part D and Prescription Opioid Overdose Death Among Veterans

Cited by 26 publications

References 48 publications

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Diabetes care management patterns before and after a cancer diagnosis: A SEER‐Medicare matched cohort study

Misalignment of Stakeholder Incentives in the Opioid Crisis

Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers

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