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Rhudy C, Perry C, Wesley M, Fardo D, Bumgardner C, Hassan S, Barrett T, Talbert J. Applying Machine Learning Models Derived From Administrative Claims Data to Predict Medication Nonadherence in Patients Self-Administering Biologic Medications for Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2024; 6:otae039. [PMID: 39050112 PMCID: PMC11266807 DOI: 10.1093/crocol/otae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Indexed: 07/27/2024] Open
Abstract
Background Adherence to self-administered biologic therapies is important to induce remission and prevent adverse clinical outcomes in Inflammatory bowel disease (IBD). This study aimed to use administrative claims data and machine learning methods to predict nonadherence in an academic medical center test population. Methods A model-training dataset of beneficiaries with IBD and the first unique dispense of a self-administered biologic between June 30, 2016 and June 30, 2019 was extracted from the Commercial Claims and Encounters and Medicare Supplemental Administrative Claims Database. Known correlates of medication nonadherence were identified in the dataset. Nonadherence to biologic therapies was defined as a proportion of days covered ratio <80% at 1 year. A similar dataset was obtained from a tertiary academic medical center's electronic medical record data for use in model testing. A total of 48 machine learning models were trained and assessed utilizing the area under the receiver operating characteristic curve as the primary measure of predictive validity. Results The training dataset included 6998 beneficiaries (n = 2680 nonadherent, 38.3%) while the testing dataset included 285 patients (n = 134 nonadherent, 47.0%). When applied to test data, the highest performing models had an area under the receiver operating characteristic curve of 0.55, indicating poor predictive performance. The majority of models trained had low sensitivity and high specificity. Conclusions Administrative claims-trained models were unable to predict biologic medication nonadherence in patients with IBD. Future research may benefit from datasets with enriched demographic and clinical data in training predictive models.
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Affiliation(s)
- Christian Rhudy
- Department of Pharmacy Services, University of Kentucky Healthcare,Lexington, KY, USA
| | - Courtney Perry
- Division of Digestive Diseases and Nutrition, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Michael Wesley
- Department of Behavioral Science, Psychiatry and Psychology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - David Fardo
- Department of Biostatistics, University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Cody Bumgardner
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Syed Hassan
- Division of Digestive Diseases and Nutrition, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Terrence Barrett
- Division of Digestive Diseases and Nutrition, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jeffery Talbert
- Division of Biomedical Informatics, University of Kentucky College of Medicine, Lexington, KY, USA
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Telfer L, Dalessio S, Tinsley A, Coates M. Short-Term and Long-Term Opioid Use Is Associated With Poor Outcomes in Outpatients With Inflammatory Bowel Disease. GASTRO HEP ADVANCES 2023; 2:1022-1024. [PMID: 38094225 PMCID: PMC10718513 DOI: 10.1016/j.gastha.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Affiliation(s)
- L. Telfer
- Penn State College of Medicine, Hershey, Pennsylvania
| | - S. Dalessio
- Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, Pennsylvania
| | - A. Tinsley
- Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, Pennsylvania
| | - M. Coates
- Division of Gastroenterology & Hepatology, Penn State College of Medicine, Hershey, Pennsylvania
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Baillie S, Limdi JK, Bassi A, Fraser A, Parkes G, Scott G, Raine T, Lamb CA, Kennedy NA, Fumis N, Smith MA, Nicolaou A, Emms H, Wye J, Lehmann A, Carbery I, Goodhand J, Lees R, Beshyah W, Luthra P, Pollok R, Selinger C. Opioid use and associated factors in 1676 patients with inflammatory bowel disease: a multicentre quality improvement project. Frontline Gastroenterol 2023; 14:497-504. [PMID: 37854782 PMCID: PMC10579551 DOI: 10.1136/flgastro-2023-102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/30/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Despite its association with poorer outcomes, opioid use in inflammatory bowel disease (IBD) is not well characterised in the UK. We aimed to examine the extent of opioid use, the associated factors and the use of mitigation techniques such as pain-service review and opioid weaning plans among individuals with IBD. Methods Data were collected from consecutive patients attending IBD outpatient appointments at 12 UK hospitals. A predefined questionnaire was used to collect data including patient demographics, IBD history, opioid use in the past year (>2 weeks) and opioid-use mitigation techniques. Additionally, consecutive IBD-related hospital stays leading up to July 2019 were reviewed with data collected regarding opioid use at admission, discharge and follow-up as well as details of the admission indication. Results In 1352 outpatients, 12% had used opioids within the past 12 months. Over half of these individuals were taking opioids for non-IBD pain and less than half had undergone an attempted opioid wean.In 324 hospitalised patients, 27% were prescribed opioids at discharge from hospital. At 12 months postdischarge, 11% were using opioids. Factors associated with opioid use in both cohorts included female sex, Crohn's disease and previous surgery. Conclusions 1 in 10 patients with IBD attending outpatient appointments were opioid exposed in the past year while a quarter of inpatients were discharged with opioids, and 11% continued to use opioids 12 months after discharge. IBD services should aim to identify patients exposed to opioids, reduce exposure where possible and facilitate access to alternative pain management approaches.
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Affiliation(s)
- Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jimmy K Limdi
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ash Bassi
- Department of Gastroenterology, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Aileen Fraser
- Department of Gastroenterology, University Hospitals Bristol and Weston Trust, Bristol, UK
| | - Gareth Parkes
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Glyn Scott
- Department of Gastroenterology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christopher A Lamb
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Gastroenterology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Exeter IBD Research Group, University of Exeter, Exeter, UK
| | - Natalia Fumis
- Department of Gastroenterology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Melissa A Smith
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Andrew Nicolaou
- Pain Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Holly Emms
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - John Wye
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anouk Lehmann
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Isabel Carbery
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Goodhand
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Robert Lees
- Department of Gastroenterology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Waleed Beshyah
- Department of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Pavit Luthra
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Oseni E, Sultan K. Letter: opioid use, early biologic discontinuation for inflammatory bowel disease and a cautionary note for the age of legalised cannabis. Aliment Pharmacol Ther 2021; 54:92-93. [PMID: 34109673 DOI: 10.1111/apt.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Ellen Oseni
- Division of Medicine, Northwell Health: North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
| | - Keith Sultan
- Department of Gastroenterology, Northwell Health: North Shore University Hospital and Long Island Jewish Medical Center, Manhasset, NY, USA
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