Austin S Kilaru1, Manqing Liu2, Ravi Gupta3, Jeanmarie Perrone4, M Kit Delgado4, Zachary F Meisel4, Margaret Lowenstein5. 1. National Clinician Scholars Program at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. Electronic address: austin.kilaru@pennmedicine.upenn.edu. 2. Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 3. National Clinician Scholars Program at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 4. Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 5. Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Department of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
Abstract
OBJECTIVE: To determine the rate at which commercially-insured patients fill prescriptions for naloxone after an opioid-related ED encounter as well as patient characteristics associated with obtaining naloxone. METHODS: This is a retrospective cohort study of adult patients discharged from the ED following treatment for an opioid-related condition from 2016 to 2018 using a commercial insurance claims database (Optum Clinformatics® Data Mart). The primary outcome was a pharmacy claim for naloxone in the 30 days following the ED encounter. A multivariable logistic regression model examined the association of patient characteristics with filled naloxone prescriptions, and predictive margins were used to report adjusted probabilities with 95% confidence intervals. RESULTS: 21,700 patients had opioid-related ED encounters during the study period, of which 1743 (8.0%) had encounters for heroin overdose, 8825 (40.7%) for overdose due to other opioids, 5400 (24.9%) for withdrawal, and 5732 (26.4%) for other opioid use disorder conditions. 230 patients (1.1%) filled a prescription for naloxone within 30 days. Patients with heroin overdose (2.6%; 95%CI 1.7 to 3.4), recent prescriptions for opioid analgesics (1.4%; 95%CI 1.1 to 1.7), recent prescriptions for buprenorphine (1.9%; 95%CI 1.0 to 2.9), and naloxone prescriptions in the prior year (3.3%; 95%CI 1.8 to 4.8) were more likely to obtain naloxone. The rate was significantly higher in 2018 [1.9% (95%CI 1.5 to 2.2)] as compared to 0.4% (95%CI 0.3 to 0.6) in 2016. CONCLUSIONS: Few patients use insurance to obtain naloxone by prescription following opioid-related ED encounters. Clinical and policy interventions should expand distribution of this life-saving medication in the ED. Published by Elsevier Inc.
OBJECTIVE: To determine the rate at which commercially-insured patients fill prescriptions for naloxone after an opioid-related ED encounter as well as patient characteristics associated with obtaining naloxone. METHODS: This is a retrospective cohort study of adult patients discharged from the ED following treatment for an opioid-related condition from 2016 to 2018 using a commercial insurance claims database (Optum Clinformatics® Data Mart). The primary outcome was a pharmacy claim for naloxone in the 30 days following the ED encounter. A multivariable logistic regression model examined the association of patient characteristics with filled naloxone prescriptions, and predictive margins were used to report adjusted probabilities with 95% confidence intervals. RESULTS: 21,700 patients had opioid-related ED encounters during the study period, of which 1743 (8.0%) had encounters for heroin overdose, 8825 (40.7%) for overdose due to other opioids, 5400 (24.9%) for withdrawal, and 5732 (26.4%) for other opioid use disorder conditions. 230 patients (1.1%) filled a prescription for naloxone within 30 days. Patients with heroin overdose (2.6%; 95%CI 1.7 to 3.4), recent prescriptions for opioid analgesics (1.4%; 95%CI 1.1 to 1.7), recent prescriptions for buprenorphine (1.9%; 95%CI 1.0 to 2.9), and naloxone prescriptions in the prior year (3.3%; 95%CI 1.8 to 4.8) were more likely to obtain naloxone. The rate was significantly higher in 2018 [1.9% (95%CI 1.5 to 2.2)] as compared to 0.4% (95%CI 0.3 to 0.6) in 2016. CONCLUSIONS: Few patients use insurance to obtain naloxone by prescription following opioid-related ED encounters. Clinical and policy interventions should expand distribution of this life-saving medication in the ED. Published by Elsevier Inc.
Entities:
Keywords:
Access to care; Emergency care systems; Health policy; Naloxone; Opioid use disorder; Overdose prevention
Authors: Elizabeth A Samuels; Gail D'Onofrio; Kristen Huntley; Scott Levin; Jeremiah D Schuur; Gavin Bart; Kathryn Hawk; Betty Tai; Cynthia I Campbell; Arjun K Venkatesh Journal: Ann Emerg Med Date: 2018-10-11 Impact factor: 5.721
Authors: Lewei Allison Lin; Chad M Brummett; Jennifer F Waljee; Michael J Englesbe; Vidhya Gunaseelan; Amy S B Bohnert Journal: J Gen Intern Med Date: 2020-02 Impact factor: 5.128
Authors: Alexander Y Walley; Ziming Xuan; H Holly Hackman; Emily Quinn; Maya Doe-Simkins; Amy Sorensen-Alawad; Sarah Ruiz; Al Ozonoff Journal: BMJ Date: 2013-01-30
Authors: Margaret Lowenstein; Jeanmarie Perrone; Ruiying A Xiong; Christopher K Snider; Nicole O'Donnell; Davis Hermann; Roy Rosin; Julie Dees; Rachel McFadden; Utsha Khatri; Zachary F Meisel; Nandita Mitra; M Kit Delgado Journal: Ann Emerg Med Date: 2021-12-23 Impact factor: 5.721
Authors: Kao-Ping Chua; Chin Hwa Y Dahlem; Thuy D Nguyen; Chad M Brummett; Rena M Conti; Amy S Bohnert; Aaron D Dora-Laskey; Keith E Kocher Journal: Ann Emerg Med Date: 2021-11-19 Impact factor: 5.721
Authors: Margaret Lowenstein; Hareena K Sangha; Anthony Spadaro; Jeanmarie Perrone; M Kit Delgado; Anish K Agarwal Journal: Harm Reduct J Date: 2022-08-26
Authors: Anish K Agarwal; Hareena K Sangha; Anthony Spadaro; Rachel Gonzales; Jeanmarie Perrone; M Kit Delgado; Margaret Lowenstein Journal: JAMA Netw Open Date: 2022-03-01