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Coughlin LN, Zhang L, Bohnert ASB, Maust DT, Goldstick J, Lin LA. Patient characteristics and treatment utilization in fatal stimulant-involved overdoses in the United States Veterans Health Administration. Addiction 2022; 117:998-1008. [PMID: 34648209 DOI: 10.1111/add.15714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS This study aimed to (1) describe trends in stimulant-alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant-related overdose death profiles. DESIGN Retrospective cohort study of patients who died from stimulant-involved overdose between annual years 2012 and 2018. SETTING United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant-involved overdose, as identified through the National Death Index. MEASUREMENTS Stimulant-involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co-involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine. FINDINGS The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine-involved overdoses, methamphetamine-involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06-0.87 aged 65+ versus 18-29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43-5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41-0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29-0.68). CONCLUSIONS The rate of deaths among US Veterans from stimulant-related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health-care use, point to distinct treatment needs based on stimulant use type.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
| | - Lan Zhang
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Donovan T Maust
- Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jason Goldstick
- University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
| | - Lewei Allison Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.,Department of Veteran Affairs Healthcare System, VA Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA.,University of Michigan Injury Prevention Center, Ann Arbor, MI, USA
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Lin LA, Bohnert ASB, Blow FC, Gordon AJ, Ignacio RV, Kim HM, Ilgen MA. Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration. Addiction 2021; 116:96-104. [PMID: 32428386 DOI: 10.1111/add.15116] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
AIMS To understand the role of comorbid substance use disorders (SUDs), or polysubstance use, in the treatment of opioid use disorder (OUD), this study compared patients with OUD only to those with additional SUDs and examined association with OUD treatment receipt. DESIGN, SETTING AND PARTICIPANTS Retrospective national cohort study of Veterans diagnosed with OUD (n = 65 741) receiving care from the US Veterans Health Administration (VHA) in fiscal year (FY) 2017. MEASUREMENTS Patient characteristics were compared among those diagnosed with OUD only versus those with one other SUD (OUD + 1 SUD) and with multiple SUDs (OUD + ≥ 2 SUDs). The study examined the relationship between comorbid SUDs and receipt of buprenorphine, methadone and SUD outpatient treatment during 1-year follow-up, adjusting for patient demographic characteristics and clinical conditions. FINDINGS Among the 65 741 Veterans with OUD in FY 2017, 41.2% had OUD only, 22.9% had OUD + 1 SUD and 35.9% had OUD + ≥ 2 SUDs. Common comorbid SUDs included alcohol use disorder (41.3%), cocaine/stimulant use disorder (30.0%) and cannabis use disorder (22.4%). Adjusting for patient characteristics, patients with OUD + 1 SUD [adjusted odds ratio (aOR) = 0.87, 95% confidence interval (CI) = 0.82-0.93] and patients with OUD +≥ 2 SUDs (aOR = 0.65, 95% CI = 0.61-0.69) had lower odds of receiving buprenorphine compared with OUD only patients. There were also lower odds of receiving methadone for patients with OUD + 1 SUD (aOR = 0.91, 95% CI = 0.86-0.97)and for those with OUD + ≥2 SUDs (aOR = 0.79, 95% CI = 0.74-0.84). Patients with OUD + 1 SUD (aOR = 1.85, 95% CI = 1.77-1.93) and patients with OUD + ≥2 SUDs (aOR = 3.25, 95% CI = 3.103.41) were much more likely to have a SUD clinic visit. CONCLUSIONS The majority of Veterans in the US Veterans Health Administration diagnosed with opioid use disorder appeared to have at least one comorbid substance use disorder and many have multiple substance use disorders. Despite the higher likelihood of a substance use disorder clinic visit, having a non-opioid substance use disorder is associated with lower likelihood of buprenorphine treatment, suggesting the importance of addressing polysubstance use within efforts to expand treatment for opioid use disorder.
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Affiliation(s)
- Lewei A Lin
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Amy S B Bohnert
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Frederic C Blow
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Rosalinda V Ignacio
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - H Myra Kim
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI, USA
| | - Mark A Ilgen
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Dodd N, Mansfield E, Carey M, Oldmeadow C, Sanson-Fisher R. Have we increased our efforts to identify strategies which encourage colorectal cancer screening in primary care patients? A review of research outputs over time. Prev Med Rep 2018; 11:100-104. [PMID: 29963366 PMCID: PMC6022456 DOI: 10.1016/j.pmedr.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023] Open
Abstract
Globally, colorectal cancer (CRC) screening rates remain suboptimal. Primary care practitioners are supported by clinical practice guidelines which recommend they provide routine CRC screening advice. Published research can provide evidence to improve CRC screening in primary care, however this is dependent on the type and quality of evidence being produced. This review aimed to provide a snapshot of trends in the type and design quality of research reporting CRC screening among primary care patients across three time points: 1993-1995, 2003-2005 and 2013-2015. Four databases were searched using MeSH headings and keywords. Publications in peer-reviewed journals which reported primary data on CRC screening uptake among primary care patients were eligible for inclusion. Studies meeting eligibility criteria were coded as observational or intervention. Intervention studies were further coded to indicate whether or not they met Effective Practice and Organisation of Care (EPOC) study design criteria. A total of 102 publications were included. Of these, 65 reported intervention studies and 37 reported observational studies. The proportion of each study type did not change significantly over time. The majority of intervention studies met EPOC design criteria at each time point. The majority of research in this field has focused on testing strategies to increase CRC screening in primary care patients, as compared to research describing rates of CRC screening in this population. Further research is needed to determine which effective interventions are most likely to be adopted into primary care.
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Affiliation(s)
- Natalie Dodd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Increasing colorectal cancer screening in an overdue population: participation and cost impacts of adding telephone calls to a FIT mailing program. J Community Health 2014; 39:239-47. [PMID: 24499966 DOI: 10.1007/s10900-014-9830-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.
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Affiliation(s)
- Jennifer A Schlichting
- VA Office of Rural Health, Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, USA
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