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Bart G, Korthuis PT, Donohue JM, Hagedorn HJ, Gustafson DH, Bazzi AR, Enns E, McNeely J, Ghitza UE, Magane KM, Baukol P, Vena A, Harris J, Voronca D, Saitz R. Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder. Addict Sci Clin Pract 2024; 19:29. [PMID: 38600571 PMCID: PMC11007900 DOI: 10.1186/s13722-024-00455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. METHODS Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. DISCUSSION Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. TRIAL REGISTRATION NCT04921787.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin Healthcare and University of Minnesota, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - P Todd Korthuis
- Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, 97239-3098, Portland, OR, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, 15261, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, University of Minnesota, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Dave H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin, 1513 University Ave., Madison, WI, 53706, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego; La Jolla, CA, USA
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN, 55408, USA
| | - Jennifer McNeely
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN), Bethesda, MD, 20892, USA
| | - Kara M Magane
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave, Ste. PP7.700, Minneapolis, MN, 55415, USA
| | - Ashley Vena
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Jacklyn Harris
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Delia Voronca
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
- Currently: Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, Deceased, NY, 10591-6707, USA
| | - Richard Saitz
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
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Hammerslag L, Talbert J, Donohue JM, Sharbaugh M, Ahrens K, Allen L, Austin AE, Gordon AJ, Jarlenski M, Kim JY, Mohamoud S, Tang L, Burns M. Urine drug testing among Medicaid enrollees initiating buprenorphine treatment for opioid use disorder within 9 MODRN states. Drug Alcohol Depend 2023; 250:110875. [PMID: 37413960 PMCID: PMC10529442 DOI: 10.1016/j.drugalcdep.2023.110875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Treatment guidelines recommend regular urine drug testing (UDT) for persons initiating buprenorphine for opioid use disorder (OUD). However, little is known about UDT utilization. We describe state variation in UDT utilization and examine demographic, health, and health care utilization factors associated with UDT in Medicaid. METHODS We used Medicaid claims and enrollment data from persons initiating buprenorphine treatment for OUD during 2016-2019 in 9 states (DE, KY, MD, ME, MI, NC, PA, WI, WV). The main outcome was at least 1 UDT within 180 days of buprenorphine initiation, the secondary outcome was at least 3. Logistic regression models included demographics, pre-initiation comorbidities, and health service use. State estimates were pooled using meta-analysis. RESULTS The study cohort included 162,437 Medicaid enrollees initiating buprenorphine. The percent receiving ≥1 UDT varied from 62.1% to 89.8% by state. In the pooled analysis, enrollees with pre-initiation UDT had much higher odds of ≥1 UDT after initiation (aOR=3.83, 3.09-4.73); odds were also higher for enrollees with HIV, HCV, and/or HBV infection (aOR=1.25, 1.05-1.48) or who initiated in later years (2018 v 2016: aOR=1.39, 1.03-1.89; 2019 v 2016: aOR=1.67, 1.24-2.25). The odds of having ≥3 UDT were lower with pre-initiation opioid overdose (aOR=0.79, 0.64-0.96) and higher with pre-initiation UDT (aOR=2.63, 2.13-3.25) or OUD care (aOR=1.35, 1.04-1.74). The direction of associations with demographics varied by state. CONCLUSIONS Rates of UDT increased over time and there was variability among states in UDT rates and demographic predictors of UDT. Pre-initiation conditions, UDT, and OUD care were associated with UDT.
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Affiliation(s)
- Lindsey Hammerslag
- Division of Biomedical Informatics, College of Medicine, University of Kentucky, United States.
| | - Jeffery Talbert
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, United States
| | - Julie M Donohue
- Health Policy and Management, University of Pittsburgh School of Public Health, United States
| | - Michael Sharbaugh
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, United States
| | - Katherine Ahrens
- University of Southern Maine, Muskie School of Public Service, United States
| | - Lindsay Allen
- Feinberg School of Medicine, Northwestern University, United States
| | - Anna E Austin
- Gillings School of Global Public Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Department of Internal Medicine, University of Utah School of Medicine and VA Salt Lake City Health Care System, United States
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, United States
| | - Joo Yeon Kim
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, United States
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland Baltimore County, United States
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh School of Public Health, United States
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, United States
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Patel PS, Pandya DM, Shah M. A holistic review on the assessment of groundwater quality using multivariate statistical techniques. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:85046-85070. [PMID: 37410329 DOI: 10.1007/s11356-023-27605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/09/2023] [Indexed: 07/07/2023]
Abstract
Water is an essential element in nature. It is used in drinking, irrigation, and industry mainly. Human health is directly linked to groundwater quality and is affected by poor groundwater quality caused by excessive fertilizer application and unhygienic circumstances. Because of increased pollution, investigating the water quality became a point of research for many researchers. There are numerous approaches to assessing water quality, and statistical methods are essential among them. This review paper discusses Multivariate Statistical Techniques, including Cluster Analysis, Principal Component Analysis, Factor Analysis, Geographical Information System, and Analysis of Variance, to name a few. We have presented the significance of each method concisely and how it is being used. In addition, an extensive table is prepared to demonstrate the individual technique along with the computational tool, the type of water bodies, and their respective regions. The advantages and disadvantages of the statistical techniques are also discussed therein. It is found that Principal Component Analysis and Factor Analysis are widely explored techniques.
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Affiliation(s)
- Praharsh S Patel
- Department of Mathematics, School of Technology, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382426, Gujarat, India
| | - Dishant M Pandya
- Department of Mathematics, School of Technology, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382426, Gujarat, India.
| | - Manan Shah
- Department of Chemical Engineering, School of Energy Technology, Pandit Deendayal Energy University, Raisan, Gandhinagar, 382426, Gujarat, India
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Austin AE, Tang L, Kim JY, Allen L, Barnes AJ, Chang CCH, Clark S, Cole ES, Durrance CP, Donohue JM, Gordon AJ, Huskamp HA, McDuffie MJ, Mehrotra A, Mohamoud S, Talbert J, Ahrens KA, Applegate M, Hammerslag LR, Lanier P, Tossone K, Zivin K, Burns ME. Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs. JAMA HEALTH FORUM 2023; 4:e231422. [PMID: 37327009 PMCID: PMC10276306 DOI: 10.1001/jamahealthforum.2023.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic. Objectives To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE). Design, Setting, and Participants This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022. Exposures Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020). Main Outcomes and Measures Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation. Results Among a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE. Conclusions and Relevance In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic-related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth.
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Affiliation(s)
- Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | - Lu Tang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joo Yeon Kim
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lindsay Allen
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Chung-Chou H. Chang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Clark
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor
| | - Evan S. Cole
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Julie M. Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J. Gordon
- Department of Internal Medicine, University of Utah, Salt Lake City
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Mary Joan McDuffie
- Center for Community Research and Service, Joseph R. Biden, Jr. School of Public Policy and Administration, University of Delaware, Newark
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Shamis Mohamoud
- The Hilltop Institute, University of Maryland, Baltimore County, Baltimore
| | - Jeffery Talbert
- Institute for Biomedical Informatics, University of Kentucky, Lexington
| | - Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland
| | | | | | - Paul Lanier
- School of Social Work, The University of North Carolina at Chapel Hill
| | - Krystel Tossone
- The Ohio Colleges of Medicine, Government Resource Center, College of Medicine, The Ohio State University, Columbus
| | - Kara Zivin
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor
| | - Marguerite E. Burns
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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Allen L, Cole E, Sharbaugh M, Austin A, Burns M, Ho Chang CC, Clark S, Crane D, Cunningham P, Durrance C, Fry C, Gordon A, Hammerslag L, Kim JY, Kennedy S, Krishnan S, Mauk R, Talbert J, Tang L, Donohue JM. Use of residential opioid use disorder treatment among Medicaid enrollees in nine states. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209034. [PMID: 37059269 PMCID: PMC10719813 DOI: 10.1016/j.josat.2023.209034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Residential treatment is a key component of the opioid use disorder care continuum, but research has not measured well the differences in its use across states at the enrollee level. METHODS This cross-sectional observational study used Medicaid claims data from nine states to document the prevalence of residential treatment for opioid use disorder and to describe the characteristics of patients receiving care. For each patient characteristic, chi-square and t-tests tested for differences in the distribution between individuals who did and did not receive residential care. RESULTS Among 491,071 Medicaid enrollees with opioid use disorder, 7.5 % were treated in residential facilities in 2019, though this number ranged widely (0.3-14.6 %) across states. Residential patients were more likely to be younger, non-Hispanic White, male, and living in an urban area. Although residential patients were less likely than those without residential care to be eligible for Medicaid through disability, diagnoses for comorbid conditions were more frequently observed among residential patients. CONCLUSIONS Results from this large, multi-state study add context to the ongoing national conversation around opioid use disorder treatment and policy, providing a baseline for future work.
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Affiliation(s)
| | - Evan Cole
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Anna Austin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States of America
| | - Chung-Chou Ho Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | | | | | | | - Carrie Fry
- Vanderbilt University, Nashville, TN, USA
| | | | | | - Joo Yeon Kim
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | | | | | | | - Lu Tang
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Austin AE, Durrance CP, Ahrens KA, Chen Q, Hammerslag L, McDuffie MJ, Talbert J, Lanier P, Donohue JM, Jarlenski M. Duration of medication for opioid use disorder during pregnancy and postpartum by race/ethnicity: Results from 6 state Medicaid programs. Drug Alcohol Depend 2023; 247:109868. [PMID: 37058829 PMCID: PMC10198927 DOI: 10.1016/j.drugalcdep.2023.109868] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Medication for opioid use disorder (MOUD) is evidence-based treatment during pregnancy and postpartum. Prior studies show racial/ethnic differences in receipt of MOUD during pregnancy. Fewer studies have examined racial/ethnic differences in MOUD receipt and duration during the first year postpartum and in the type of MOUD received during pregnancy and postpartum. METHODS We used Medicaid administrative data from 6 states to compare the percentage of women with any MOUD and the average proportion of days covered (PDC) with MOUD, overall and by type of MOUD, during pregnancy and four postpartum periods (1-90 days, 91-180 days, 181-270 days, and 271-360 days postpartum) among White non-Hispanic, Black non-Hispanic, and Hispanic women diagnosed with OUD. RESULTS White non-Hispanic women were more likely to receive any MOUD during pregnancy and all postpartum periods compared to Hispanic and Black non-Hispanic women. For all MOUD types combined and for buprenorphine, White non-Hispanic women had the highest average PDC during pregnancy and each postpartum period, followed by Hispanic women and Black non-Hispanic women (e.g., for all MOUD types, 0.49 vs. 0.41 vs. 0.23 PDC, respectively, during days 1-90 postpartum). For methadone, White non-Hispanic and Hispanic women had similar average PDC during pregnancy and postpartum, and Black non-Hispanic women had substantially lower PDC. CONCLUSIONS There are stark racial/ethnic differences in MOUD during pregnancy and the first year postpartum. Reducing these inequities is critical to improving health outcomes among pregnant and postpartum women with OUD.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health and Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States.
| | | | - Katherine A Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, United States
| | - Qingwen Chen
- Department of Health Policy and Management, University of Pittsburgh, United States
| | - Lindsey Hammerslag
- Institute for Biomedical Informatics, University of Kentucky, United States
| | - Mary Joan McDuffie
- Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, United States
| | - Jeffery Talbert
- Institute for Biomedical Informatics, University of Kentucky, United States
| | - Paul Lanier
- School of Social Work, University of North Carolina at Chapel Hill, United States
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, United States
| | - Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, United States
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7
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Ahrens K, Sharbaugh M, Jarlenski MP, Tang L, Allen L, Austin AE, Barnes AJ, Burns ME, Clark S, Zivin K, Mack A, Liu G, Mohamoud S, McDuffie MJ, Hammerslag L, Gordon AJ, Donohue JM. Prevalence of Testing for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Among Medicaid Enrollees Treated With Medications for Opioid Use Disorder in 11 States, 2016-2019. Clin Infect Dis 2023; 76:1793-1801. [PMID: 36594172 PMCID: PMC10209438 DOI: 10.1093/cid/ciac981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/21/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Limited information exists about testing for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among Medicaid enrollees after starting medication for opioid use disorder (MOUD), despite guidelines recommending such testing. Our objectives were to estimate testing prevalence and trends for HIV, HBV, and HCV among Medicaid enrollees initiating MOUD and examine enrollee characteristics associated with testing. METHODS We conducted a serial cross-sectional study of 505 440 initiations of MOUD from 2016 to 2019 among 361 537 Medicaid enrollees in 11 states. Measures of MOUD initiation; HIV, HBV, and HCV testing; comorbidities; and demographics were based on enrollment and claims data. Each state used Poisson regression to estimate associations between enrollee characteristics and testing prevalence within 90 days of MOUD initiation. We pooled state-level estimates to generate global estimates using random effects meta-analyses. RESULTS From 2016 to 2019, testing increased from 20% to 25% for HIV, from 22% to 25% for HBV, from 24% to 27% for HCV, and from 15% to 19% for all 3 conditions. Adjusted rates of testing for all 3 conditions were lower among enrollees who were male (vs nonpregnant females), living in a rural area (vs urban area), and initiating methadone or naltrexone (vs buprenorphine). Associations between enrollee characteristics and testing varied across states. CONCLUSIONS Among Medicaid enrollees in 11 US states who initiated medications for opioid use disorder, testing for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and all 3 conditions increased between 2016 and 2019 but the majority were not tested.
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Affiliation(s)
- Katherine Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Michael Sharbaugh
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marian P Jarlenski
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lu Tang
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Lindsay Allen
- Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew J Barnes
- Health Behavior and Policy Department, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marguerite E Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah Clark
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kara Zivin
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aimee Mack
- Government Resource Center, Ohio Colleges of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Gilbert Liu
- Government Resource Center, Ohio Colleges of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Shamis Mohamoud
- Hilltop Institute, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Mary Joan McDuffie
- Center for Community Research & Service, Biden School of Public Policy and Administration, University of Delaware, Newark, Delaware, USA
| | - Lindsey Hammerslag
- College of Medicine, Institute for Biomedical Informatics, University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy, Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
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Cole ES, Allen L, Austin A, Barnes A, Chang CCH, Clark S, Crane D, Cunningham P, Fry CE, Gordon AJ, Hammerslag L, Idala D, Kennedy S, Kim JY, Krishnan S, Lanier P, Mahakalanda S, Mauk R, McDuffie MJ, Mohamoud S, Talbert J, Tang L, Zivin K, Donohue JM. Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states. Drug Alcohol Depend 2022; 241:109670. [PMID: 36332591 PMCID: PMC10756712 DOI: 10.1016/j.drugalcdep.2022.109670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/04/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Follow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes. METHODS Using a distributed research network to analyze Medicaid claims data, we estimated the likelihood of 4 outcomes occurring within 7 and 30 days post-discharge from residential treatment for OUD using multinomial logit regression: no follow-up or MOUD, follow-up visit only, MOUD only, or both follow-up and MOUD. We used meta-analysis techniques to pool state-specific estimates into global estimates. RESULTS We identified 90,639 episodes of residential treatment for OUD for 69,017 enrollees from 2018 to 2019. We found that 62.5% and 46.9% of episodes did not receive any follow-up or MOUD at 7 days and 30 days, respectively. In adjusted analyses, co-occurring mental health conditions, longer lengths of stay, prior receipt of MOUD or behavioral health counseling, and a recent ED visit for OUD were associated with a greater likelihood of receiving follow-up treatment including MOUD after discharge. CONCLUSIONS Forty-seven percent of residential treatment episodes for Medicaid enrollees are not followed by an outpatient visit or MOUD, and thus are not following best practices.
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Affiliation(s)
- Evan S Cole
- University of Pittsburgh, A616, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | | | - Anna Austin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | - Lu Tang
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Kara Zivin
- University of Michigan, Ann Arbor, MI, USA
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Dihwa V, Shadowen H, Barnes AJ. Medicaid can and should play an active role in advancing health equity. Health Serv Res 2022; 57 Suppl 2:167-171. [PMID: 36125126 PMCID: PMC9660413 DOI: 10.1111/1475-6773.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Vimbainashe Dihwa
- Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Hannah Shadowen
- Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Andrew J. Barnes
- Health Behavior and Policy, School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
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