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Blanchette JE, Lewis CB, Shannon CS, Kanchibhatla A, Rieke J, Roche MJ, Johnson DA, Williams D, Webb S, Diaz CN, Lundgrin EL, Allen NA, Litchman ML, Hatipoglu B. Empowering emerging adults with type 1 diabetes: crafting a financial and health insurance toolkit through community-based participatory action research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:75. [PMID: 39044303 PMCID: PMC11265338 DOI: 10.1186/s40900-024-00602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Emerging adults aged 18-30 years face challenges during life transitions, with an added burden of navigating the health care system and additional costs associated with diabetes. This stress is compounded by overall low levels of health insurance literacy in this population, as people may not know about available financial and health care resources to minimize suboptimal diabetes outcomes. This study aimed to tailor a financial and health insurance toolkit to emerging adults with type 1 diabetes, including racially, ethnically diverse, and Medicaid-insured individuals, through community-based participatory action research. METHODS An academic research team and community members from a national organization held six online community advisory board (CAB) content-creation meetings to understand how to tailor a financial and health insurance Toolkit. The CAB was comprised of six racially and insurance-diverse emerging adults with type 1 diabetes and four content experts (clinical, financial, and insurance). Six 60-minute online CAB meetings were held via University Hospitals (UH)-encrypted Zoom over five months. Pre-reading materials were emailed to CAB members before the meetings. A moderator established the purpose of each meeting and briefly discussed meeting rules before each meeting commenced. During the meetings, the moderator guided the discussions and provided the CAB members opportunities to respond and build on one another's feedback. A deductive thematic qualitative analysis was utilized. Three researchers independently coded the cross-referenced and de-identified CAB meeting transcripts and then convened to reach a group consensus. Two CAB members performed member-checking. RESULTS The following key themes emerged to tailor the Toolkit: ensuring that content covers empowerment and self-advocacy, including genuine stories and multimedia visuals for aesthetics, addressing clinician bias, acknowledging racial and ethnic disparities in care, incorporating cultural representation, and demystifying Medicaid stigma. CONCLUSIONS By successfully partnering with the CAB and a community organization through a community-based participatory action research approach, we will develop a financial and health insurance Toolkit tailored to the needs of racially and ethnically diverse and Medicaid-insured emerging adults with type 1 diabetes.
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Affiliation(s)
- Julia E Blanchette
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Claudia B Lewis
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
| | - Chantel S Shannon
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- College of Public Health, Kent State University, Kent, OH, USA
| | - Anuhya Kanchibhatla
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- Department of Nutrition, Undergraduate Studies, Case Western Reserve University, Cleveland, OH, USA
| | - Jorden Rieke
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Jane Roche
- The Diabetes Link, Boston, MA, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Dove-Anna Johnson
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Dionne Williams
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
| | - Shay Webb
- College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Crystal N Diaz
- Global Disease Biology, University of California, Davis, CA, USA
- Young Adult Living with Type 1 Diabetes/Lay Person Community Member, New Hampshire, North Carolina, California, USA
| | - Erika L Lundgrin
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Divison of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Nancy A Allen
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Betul Hatipoglu
- Department of Medicine, Diabetes and Metabolic Care Center, Division of Endocrinology, University Hospitals, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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2
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Hao S, Quinn AW, Iasiello JA, Lea CS, Popowicz P, Fu Y, Irish W, Parikh AA, Snyder RA. Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina. JCO Oncol Pract 2024:OP2300703. [PMID: 38759124 DOI: 10.1200/op.23.00703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. METHODS This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. RESULTS Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). CONCLUSION Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.
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Affiliation(s)
- Scarlett Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Ashley W Quinn
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - John A Iasiello
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - C Suzanne Lea
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Patrycja Popowicz
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Yuanyuan Fu
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - William Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgical Oncology, University of Texas Health San Antonio, San Antonio, TX
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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Fenton JJ, Magnan EM, Tancredi DJ, Tseregounis IE, Agnoli AL. Impact of overdose on health plan disenrollment among patients prescribed long-term opioids: Retrospective cohort study. Drug Alcohol Depend 2024; 258:111277. [PMID: 38581921 DOI: 10.1016/j.drugalcdep.2024.111277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
CONTEXT Health plan disenrollment may disrupt chronic or preventive care for patients prescribed long-term opioid therapy (LTOT). PURPOSE To assess whether overdose events in patients prescribed LTOT are associated with subsequent health plan disenrollment. DESIGN Retrospective cohort study. SETTING AND DATASET Data from the Optum Labs Data Warehouse which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on patients, representing a mixture of ages and geographical regions across the United States. PATIENTS Adults prescribed stable opioid therapy (≥10 morphine milligram equivalents/day) for a 6-month baseline period prior to an index opioid prescription from January 1, 2018 to December 31, 2018. MAIN MEASURES Health plan disenrollment during follow-up. RESULTS The cohort comprised 404,151 patients who were followed up after 800,250 baseline periods of stable opioid dosing. During a mean follow-up of 9.1 months, unadjusted disenrollment rates among primary commercial beneficiaries and Medicare Advantage enrollees were 37.2 and 13.9 per 100 person-years, respectively. Incident overdoses were associated with subsequent health plan disenrollment with a statistically significantly stronger association among primary commercial insurance beneficiaries [adjusted incidence rate ratio (aIRR) 1.48 (95% CI: 1.33-1.64)] as compared to Medicare Advantage enrollees [aIRR 1.15 (95% CI: 1.07-1.23)]. CONCLUSIONS Among patients prescribed long-term opioids, overdose events were strongly associated with subsequent health plan disenrollment, especially among primary commercial insurance beneficiaries. These findings raise concerns about the social consequences of overdose, including potential health insurance loss, which may limit patient access to care at a time of heightened vulnerability.
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Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA.
| | - Elizabeth M Magnan
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Iraklis Erik Tseregounis
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
| | - Alicia L Agnoli
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA, USA
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Meille G. Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky. Med Care Res Rev 2024; 81:133-144. [PMID: 38062727 DOI: 10.1177/10775587231213691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II-V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.
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Affiliation(s)
- Giacomo Meille
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Nelson DB, Goldman AL, Zhang F, Yu H. Continuous Medicaid coverage during the COVID-19 public health emergency reduced churning, but did not eliminate it. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad055. [PMID: 38223316 PMCID: PMC10786332 DOI: 10.1093/haschl/qxad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Preserving insurance coverage in the wake of pandemic-related job loss was a priority in early 2020. To this end, the Families First Coronavirus Response Act implemented a continuous coverage policy in Medicaid to shore up access to health insurance. Prior to the pandemic, Medicaid enrollees experienced frequent coverage disruptions, known as "churning." The effect of the continuous coverage policy on churning during the COVID-19 public health emergency (PHE) is unknown. We performed a difference-in-differences analysis of nonelderly Medicaid enrollees using longitudinal national survey data to compare a 2019-2020 cohort exposed to the policy with a control cohort in 2018-2019. We found that the policy led to reduced transitions to uninsurance among adults, although not among children. The policy prevented over 300 000 transitions to uninsurance each month. However, disenrollment from Medicaid persisted at a low rate, despite the continuous coverage policy. As the PHE unwinds, policymakers should consider long-term continuous coverage policies to minimize churning in Medicaid.
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Affiliation(s)
- Daniel B. Nelson
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Anna L. Goldman
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, United States
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School, Boston, MA 02215, United States
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George MP, Germack HD, Goyal A, Ward C, Studer S, Panjabi S. Impact of the COVID-19 pandemic on care disruptions, outcomes, and costs in patients receiving pulmonary arterial hypertension-specific therapy in the United States of America: An observational study. Pulm Circ 2023; 13:e12283. [PMID: 37701141 PMCID: PMC10493079 DOI: 10.1002/pul2.12283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Regular expert follow-up, risk assessment, and early therapeutic intervention minimize worsening of pulmonary arterial hypertension (PAH). COVID-19 lockdown measures were challenging for chronic disease management. This retrospective, longitudinal analysis used US claims data (January 12, 2016 to September 11, 2021) for patients treated with PAH-specific medication to compare in-person outpatient and specialist visits, telemedicine visits, and PAH-related tests during 6-month assessment periods pre- and immediately post-COVID-19. Hospitalizations, costs, and outcomes were compared in patients with and without care disruptions (no in-person or telemedicine outpatient visits in immediate post-COVID-19 period). Patients in the immediate post-COVID-19 (N = 599) versus the pre-COVID-19 period (N = 598) had fewer in-person outpatient visits (mean 1.27 vs. 2.12) and in-person specialist visits (pulmonologist, 22.9% vs. 37.0% of patients; cardiologist, 27.5% vs. 33.8%); and more telemedicine visits (mean 0.45 vs. 0.02). In the immediate post-COVID-19 period, patients were less likely to have a PAH-related test versus the pre-COVID-19 period (incidence rate ratio: 0.700; 95% confidence interval: 0.615-0.797), including electrocardiograms (41.7% vs. 54.2%) and 6-minute walk distance tests (16.2% vs. 24.9%). In the immediate post-COVID-19 period, 48 patients had care disruptions and, in the following year, required more hospital days than those without care disruptions (N = 240) (median 10 vs. 5 days in total) and had higher overall hospitalization costs (median US$34,755 vs. US$20,090). Our findings support the need for minimizing care disruptions to potentially avoid incremental post-disruption healthcare utilization and costs among patients with serious chronic diseases such as PAH.
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Affiliation(s)
| | | | | | | | - Sean Studer
- Medical AffairsJanssen Pharmaceuticals US, Inc.TitusvilleNew JerseyUSA
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Zhao J, Han X, Zheng Z, Fan Q, Shi K, Fedewa S, Yabroff KR, Nogueira L. Incarceration History and Health Insurance and Coverage Changes in the U.S. Am J Prev Med 2023; 64:334-342. [PMID: 36411143 DOI: 10.1016/j.amepre.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study examines the association of incarceration history and health insurance coverage and coverage changes in the U.S. METHODS Individuals with and without incarceration history were identified from the National Longitudinal Survey of Youth 1997 with follow-up through 2017-2018 (n=7,417). Generalized estimating equations were used to examine the associations between incarceration history and health insurance and coverage changes in the past 12 months. This study also assessed variation in associations by incarceration duration, frequency, and recency and reoffence history. Analysis was conducted in 2022. RESULTS Individuals with incarceration history were more likely to be uninsured (AOR=1.69; 95% CI=1.55, 1.85) and to experience year-long uninsurance (AOR=1.34; 95% CI=1.12, 1.59) and were less likely to have stable health insurance coverage (AOR=1.30; 95% CI=1.08, 1.56) than individuals without incarceration history. Longer duration and more frequent incarcerations were associated with a higher likelihood of lack of and unstable insurance coverage and year-long uninsurance. CONCLUSIONS People with an incarceration history had worse access to health insurance coverage. Targeted programs to improve health insurance coverage may reduce disparities associated with incarceration.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Qinjin Fan
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kewei Shi
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey Fedewa
- Department of Hematology and Oncology, School of Medicine, Emory University, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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Yabroff KR, Han X, Zhao J, Kirby J, Nogueira L, Zheng Z. Association of Health Insurance Coverage Disruptions With Mortality Risk Among US Working-Age Adults. JAMA HEALTH FORUM 2022; 3:e224258. [PMID: 36416817 PMCID: PMC9685485 DOI: 10.1001/jamahealthforum.2022.4258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This cohort study assesses associations of a prior coverage disruption with mortality risk among large, nationally representative cohorts of working-age adults with public or private health insurance coverage.
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Affiliation(s)
- K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - James Kirby
- Center for Financing, Access and Cost Trends, The Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, Georgia
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Binswanger IA, Shetterly SM, Xu S, Narwaney KJ, McClure DL, Rinehart DJ, Nguyen AP, Glanz JM. Opioid Dose Trajectories and Associations With Mortality, Opioid Use Disorder, Continued Opioid Therapy, and Health Plan Disenrollment. JAMA Netw Open 2022; 5:e2234671. [PMID: 36197665 PMCID: PMC9535531 DOI: 10.1001/jamanetworkopen.2022.34671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Uncertainty remains about the longer-term benefits and harms of different opioid management strategies, such as tapering and dose escalation. For instance, opioid tapering could help patients reduce opioid exposure to prevent opioid use disorder, but patients may also seek care elsewhere and engage in nonprescribed opioid use. OBJECTIVE To evaluate the association between opioid dose trajectories observed in practice and patient outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in 3 health systems in Colorado and Wisconsin. The study population included patients receiving long-term opioid therapy between 50 and 200 morphine milligram equivalents between August 1, 2014, and July 31, 2017. Follow-up ended on December 31, 2019. Data were analyzed from January 2020 to August 2022. EXPOSURES Group-based trajectory modeling identified 5 dosing trajectories over 1 year: 1 decreasing, 1 high-dose increasing, and 3 stable. MAIN OUTCOMES AND MEASURES Primary outcomes assessed after the trajectory period were 1-year all-cause mortality, incident opioid use disorder, continued opioid therapy at 1 year, and health plan disenrollment. Associations were tested using Cox proportional hazards regression and log-binomial models, adjusting for baseline covariates. RESULTS A total of 3913 patients (mean [SD] age, 59.2 [14.4] years; 2767 White non-Hispanic [70.7%]; 2237 female patients [57.2%]) were included in the study. Compared with stable trajectories, the decreasing dose trajectory was negatively associated with opioid use disorder (adjusted hazard ratio [aHR], 0.40; 95% CI, 0.29-0.55) and continued opioid therapy (site 1: adjusted relative risk [aRR], 0.39; 95% CI, 0.34-0.44), but was positively associated with health plan disenrollment (aHR, 1.66; 95% CI, 1.24-2.22). The decreasing trajectory was not associated with mortality (aHR, 1.28; 95% CI, 0.87-1.86). In contrast, the high-dose increasing trajectory was positively associated with mortality (aHR, 2.19; 95% CI, 1.44-3.32) and opioid use disorder (aHR, 1.81; 95% CI, 1.39-2.37) but was not associated with disenrollment (aHR, 0.90; 95% CI, 0.56-1.42) or continued opioid therapy (site 1: aRR, 0.98; 95% CI, 0.94-1.03). CONCLUSIONS AND RELEVANCE In this cohort study, decreasing opioid dose was associated with reduced risk of opioid use disorder and continued opioid therapy but increased risk of disenrollment compared with stable dosing, whereas the high-dose increasing trajectory was associated with an increased risk of mortality and opioid use disorder. These findings can inform opioid management decision-making.
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Affiliation(s)
- Ingrid A. Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Chemical Dependency Treatment Services, Colorado Permanente Medical Group, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Stanley Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - David L. McClure
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Deborah J. Rinehart
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, Colorado
| | - Anh P. Nguyen
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Department of Epidemiology, Colorado School of Public Health, Aurora
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10
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Nguyen AP, Glanz JM, Shoup JA, Campbell CI, Clarke CL, Ford MA, Binswanger IA. Mortality Among Patients Prescribed Buprenorphine for Opioid Use Disorder After Disenrollment from an Insurance Plan and Healthcare System. J Gen Intern Med 2022; 37:2882-2884. [PMID: 35083649 PMCID: PMC9411360 DOI: 10.1007/s11606-021-07344-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/15/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Anh P Nguyen
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA.
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, USA
| | - Christina L Clarke
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA
| | - Morgan A Ford
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite 200, Aurora, CO, 80014, USA.,Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.,Colorado Permanente Medical Group, Aurora, CO, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Kirby JB, Nogueira L, Zhao J, Yabroff KR. Do Disruptions in Health Insurance Continue to Affect Access to Care Even After Coverage Is Regained? J Gen Intern Med 2022; 37:2579-2581. [PMID: 34993858 PMCID: PMC9360292 DOI: 10.1007/s11606-021-07187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- James B Kirby
- The Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA.
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12
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Horne G, Gautam A, Tumin D. Short- and Long-Term Health Consequences of Gaps in Health Insurance Coverage among Young Adults. Popul Health Manag 2021; 25:399-406. [PMID: 34698587 DOI: 10.1089/pop.2021.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In cross-sectional data, gaps in health insurance coverage are associated with worse health and lower utilization of preventive services. The authors investigated if these associations persisted 2-6 years after disruption of insurance coverage in a cohort of young adults. Data from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of participants who were ages 13-17 years in 1997, were analyzed. Annual interview data from 2007 through 2017 were included and analyzed in 2021. Health outcomes (general self-rated health, annual preventive care use, and work-related health limitations) in each year were regressed on insurance coverage status, classified as: continuous private coverage, continuous public coverage, gap in coverage, or year-round lack of coverage. In a series of models, insurance coverage status was lagged by 2, 4, or 6 years to capture long-term associations with health outcomes. The analytic sample included 8197 young adults contributing 49,580 observations. Contemporaneous gaps in coverage were associated with 17% lower odds of reporting better self-rated health (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.78, 0.88; P < 0.001), compared to year-round private insurance. This association remained similar when the insurance covariate was lagged 2, 4, or 6 years (eg, 6-year lagged OR: 0.82; 95% CI: 0.72, 0.93; P = 0.002). Results were similar for preventive care use and work-related health limitation. Among young adults, gaps in coverage are adversely associated with health status and health care utilization up to 6 years later. Policy efforts should target insurance continuity during this life course stage.
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Affiliation(s)
- Gabrielle Horne
- Department of Sociology, East Carolina University, Greenville, North Carolina, USA
| | - Amber Gautam
- Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine,East Carolina University, Greenville, North Carolina, USA
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