Evan S Cole1, Coleman Drake2, Ellen DiDomenico3, Michael Sharbaugh2, Joo Yeon Kim2, Dylan Nagy2, Gerald Cochran4, Adam J Gordon4, Walid F Gellad5, Janice Pringle6, Jack Warwick6, Chung-Chou H Chang7, Julie Kmiec8, David Kelley9, Julie M Donohue2. 1. University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States. Electronic address: evancole@pitt.edu. 2. University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States. 3. Pennsylvania Department of Drug and Alcohol Programs 2601 N 3rd St, Harrisburg, PA, 17110, United States. 4. University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, 295 Chipeta Way, Salt Lake City, UT, 84132, United States. 5. University of Pittsburgh Graduate School of Public Health, Department of Health Policy and Management, 130 DeSoto Street, Pittsburgh, PA, 15261, United States; University of Pittsburgh School of Medicine, Division of General Internal Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States. 6. University of Pittsburgh School of Pharmacy, Program Evaluation and Research Unit 5607 Baum Blvd, Pittsburgh, PA, 15206, United States. 7. University of Pittsburgh School of Medicine, Division of General Internal Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States. 8. University of Pittsburgh, Department of Psychiatry, Thomas Detre Hall, 3811 O'Hara Street, Pittsburgh, PA, 15213, United States. 9. Pennsylvania Department of Human Services, 625 Forster St, Harrisburg, PA, 17120, United States.
Abstract
BACKGROUND: Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses. OBJECTIVE: To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose. DESIGN: Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data. MAIN MEASURES: MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose. RESULTS: Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches. CONCLUSIONS: Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
BACKGROUND: Many persons with opioid use disorder (OUD) initiate medication for opioid use disorder (MOUD) with one clinic and switch to another clinic during their course of treatment. These switches may occur for referrals or for unplanned reasons. It is unknown, however, what effect switching MOUD clinics has on continuity of MOUD treatment or on overdoses. OBJECTIVE: To examine patterns of switching MOUD clinics and its association with the proportion of days covered (PDC) by MOUD, and opioid-related overdose. DESIGN: Cross-sectional retrospective analysis of Pennsylvania Medicaid claims data. MAIN MEASURES: MOUD clinic switches (i.e., filling a MOUD prescription from a prescriber located in a different clinic than the previous prescriber), PDC, and opioid-related overdose. RESULTS: Among 14,107 enrollees, 43.2 % switched clinics for MOUD at least once during the 270 day period. In multivariate regression results, enrollees who were Non-Hispanic black (IRR = 1.43; 95 % CI = 1.24-1.65; p < 0.001), had previous methadone use (IRR = 1.32; 95 % CI = 1.13-1.55; p < 0.001), and a higher total number of office visits (IRR = 1.01; CI = 1.01-1.01; p < 0.001) had more switches. The number of clinic switches was positively associated with PDC (OR = 1.12; 95 % CI = 1.10-1.13). In secondary analyses, we found that switches for only one MOUD fill were associated with lower PDC (OR = 0.97; 95 % CI = 0.95-0.99), while switches for more than one MOUD fill were associated with higher PDC (OR = 1.40; 95 % CI = 1.36-1.44). We did not observe a relationship between opioid-related overdose and clinic switches. CONCLUSIONS: Lack of prescriber continuity for receiving MOUD may not be problematic as it is for other conditions, insofar as it is related to overdose and PDC.
Authors: Matthew L Maciejewski; Bradley G Hammill; Elizabeth A Bayliss; Laura Ding; Corrine I Voils; Lesley H Curtis; Virginia Wang Journal: Med Care Date: 2017-04 Impact factor: 2.983
Authors: Matthew L Maciejewski; Bradley G Hammill; Laura Ding; Lesley H Curtis; Elizabeth A Bayliss; Abby F Hoffman; Virginia Wang Journal: Healthc (Amst) Date: 2019-05-30