José Tomás Prieto1, Dean McEwen2, Arthur J Davidson3, Alia Al-Tayyib4, Lisa Gawenus5, Sridhar R Papagari Sangareddy6, Joshua Blum7, Seth Foldy8, Judith C Shlay8. 1. Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA; Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA. Electronic address: nto3@cdc.gov. 2. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA. 3. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA; Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Aurora, CO, USA; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 4. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. 5. Outpatient Behavioral Health Services, Denver Health and Hospital Authority, CO, USA. 6. Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA. 7. Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA. 8. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Abstract
BACKGROUND: Assessment of people affected by opioid-related problems and those receiving care is challenging due to lack of common definitions and scattered information. We sought to fill this gap by demonstrating a method to describe a continuum of opioid addiction care in a large, public safety-net institution. METHODS: Using 2017 clinical and administrative data from Denver Health (DH), we created operational definitions for opioid use disorder (OUD), opioid misuse (OM), and opioid poisoning (OP). Six stages along a continuum of patient engagement in opioid addiction care were developed, and operational definitions assigned patients to stages for a specific time point of analysis. National data was used to estimate the Denver population affected by OUD, OM and OP. RESULTS: In 2017, an estimated 6688 people aged ≥12 years were affected by OUD, OM, or OP in Denver; 48.4% (3238/6688) were medically diagnosed in DH. Of those, 32.5% (1051/3238) were in the medication assisted treatment stage, and, of those, 59.8% (629/1051) in the adhered to treatment stage. Among that latter group, 78.4% (493/629) adhered at least 90 days and 52.3% (329/629) for more than one year. Among patients who received medication assisted treatment, less than one third (31.3%, 329/1051) were adherent for more than one year. CONCLUSIONS: A health-system level view of the continuum of opioid addiction care identified improvement opportunities to better monitor accuracy of diagnosis, treatment capacity, and effectiveness of patient engagement. Applied longitudinally at local, state and national levels, the model could better synergize responses to the opioid crisis. Published by Elsevier B.V.
BACKGROUND: Assessment of people affected by opioid-related problems and those receiving care is challenging due to lack of common definitions and scattered information. We sought to fill this gap by demonstrating a method to describe a continuum of opioid addiction care in a large, public safety-net institution. METHODS: Using 2017 clinical and administrative data from Denver Health (DH), we created operational definitions for opioid use disorder (OUD), opioid misuse (OM), and opioid poisoning (OP). Six stages along a continuum of patient engagement in opioid addiction care were developed, and operational definitions assigned patients to stages for a specific time point of analysis. National data was used to estimate the Denver population affected by OUD, OM and OP. RESULTS: In 2017, an estimated 6688 people aged ≥12 years were affected by OUD, OM, or OP in Denver; 48.4% (3238/6688) were medically diagnosed in DH. Of those, 32.5% (1051/3238) were in the medication assisted treatment stage, and, of those, 59.8% (629/1051) in the adhered to treatment stage. Among that latter group, 78.4% (493/629) adhered at least 90 days and 52.3% (329/629) for more than one year. Among patients who received medication assisted treatment, less than one third (31.3%, 329/1051) were adherent for more than one year. CONCLUSIONS: A health-system level view of the continuum of opioid addiction care identified improvement opportunities to better monitor accuracy of diagnosis, treatment capacity, and effectiveness of patient engagement. Applied longitudinally at local, state and national levels, the model could better synergize responses to the opioid crisis. Published by Elsevier B.V.
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