Postpartum Opioid Use among Military Health System Beneficiaries

Objective The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. Study Design We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Results Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8–3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75–0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80–0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73–0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06–1.23). Conclusion Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. Key Points

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Opioid Use Patterns Among Active Duty Service Members and Civilians: 2006–2014

Military Medicine ◽

10.1093/milmed/usx014 ◽

2017 ◽

Vol 183 (3-4) ◽

pp. e157-e164 ◽

Cited By ~ 9

Author(s):

William Kazanis ◽

Mary J Pugh ◽

Claudina Tami ◽

Joseph K Maddry ◽

Vikhyat S Bebarta ◽

...

Keyword(s):

Health System ◽

Forecast Model ◽

Active Duty ◽

Service Members ◽

Opioid Use ◽

Military Health System ◽

Opioid Prescription ◽

Military Health ◽

Use Patterns ◽

The Military

Abstract Introduction Between 2001 and 2009, opioid analgesic prescriptions in the Military Health System quadrupled to 3.8 million. The sheer quantity of opioid analgesics available sets the stage for issues related to misuse, abuse, and diversion. To address this issue, the Department of Defense implemented several directives and clinical guidelines to improve access to appropriate pain care and safe opioid prescribing. Unfortunately, little has been done to characterize changing patterns of opioid use in active duty service members (ADSM), so little is known about how combat operations and military health care policy may have influenced this significant problem. We examined changes in opioid use for ADSM between 2006 and 2014, compared trends with the civilian population, and explored the potential role of military-specific factors in changes in opioid use in the Military Health System. Materials and Methods After obtaining Institutional Review Board approval, administrative prescription records (Pharmacy Data Transaction Records) for non-deployed ADSM were used to determine the number of opioid prescriptions dispensed each year and the proportion of ADSM who received at least one prescription per month between 2006 and 2014. Based on the observation and the literature, we identified December 2011 as the demarcation point (the optimal point to identify the downturn in opioid use) and used it to compare opioid use trends before and after. We used an autoregressive forecast model to verify changes in opioid use patterns before and after 2011. Several interrupted time series models examined whether military system-level factors were associated with changes in opioid use. Results Between 2006 and 2014, 1,516,979 ADSM filled 7,119,945 opioid prescriptions, either in military treatment facilities or purchased through TRICARE. Both active duty and civilian populations showed signs of decreasing use after 2011, but this change was much more pronounced among ADSM. The forecast model showed a significant difference after 2011 between the projected and actual proportion of ADSM filling an opioid prescription, confirming 2011 as a point of divergence in opioid use. Interrupted time series models showed that the deflection point was associated with significant decreases. A significant increase of 0.261% in opioid prescriptions was seen for every 1,000 wounded in action service members in a given month. Troops returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn did not appear to influence the rates of use. Even after accounting for returning troops from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn and wounded in action counts, the deflection point was associated with a lower proportion of ADSM who filled an opioid prescription, leading to a decrease of 1.61% by the end of the observation period (December 2014). Conclusion After December 2011, opioid use patterns significantly decreased in both civilian and ADSM populations, but more so in the military population. Many factors, such as numbers of those wounded in action and the structural organization of the Military Health System, may have caused the decline, although more than likely the decrease was influenced by many factors inside and outside of the military, including policy directives and cultural changes.

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Comparison of Nurse-Midwife and Physician Birth Outcomes in the Military Health System

Policy Politics & Nursing Practice ◽

10.1177/1527154421994071 ◽

2021 ◽

pp. 152715442199407

Author(s):

Lynette Hamlin ◽

Lindsay Grunwald ◽

Rodney X. Sturdivant ◽

Tracey P. Koehlmoos

Keyword(s):

Health System ◽

Birth Outcomes ◽

Health Care Systems ◽

Vaginal Birth ◽

Data Repository ◽

Military Health System ◽

Provider Type ◽

Pregnancy Risk ◽

Military Health ◽

The Military

The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America’s largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012–2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women’s health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.

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Behavioral Health Care in the Military Health System: Access and Quality for Remote Service Members

10.7249/rr2788 ◽

2021 ◽

Keyword(s):

Health Care ◽

Health System ◽

Behavioral Health ◽

Behavioral Health Care ◽

Service Members ◽

Military Health System ◽

Military Health ◽

Access And Quality ◽

System Access ◽

The Military

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Racial Disparities in the Military Health System: A Framework Synthesis

Military Medicine ◽

10.1093/milmed/usab506 ◽

2021 ◽

Author(s):

Tracey Pérez Koehlmoos ◽

Jessica Korona-Bailey ◽

Miranda Lynn Janvrin ◽

Cathaleen Madsen

Keyword(s):

Health Care ◽

Health System ◽

Racial Disparities ◽

Women’S Health ◽

Women's Health ◽

Military Health System ◽

Electronic Health Record Data ◽

Military Health ◽

Racial Disparities In Health ◽

The Military

ABSTRACT Introduction Racial disparities in health care are a well-documented phenomenon in the USA. Universal insurance has been suggested as a solution to mitigate these disparities. We examined race-based disparities in the Military Health System (MHS) by constructing and analyzing a framework of existing studies that measured disparities between direct care (care provided by military treatment facilities) and private sector care (care provided by civilian health care facilities). Materials and Methods We conducted a framework synthesis on 77 manuscripts published in partnership with the Comparative Effectiveness and Provider-Induced Demand Collaboration Project that use MHS electronic health record data to present an overview of racial disparities assessed for multiple treatment interventions in a nationally representative, universally insured population. Results We identified 32 studies assessing racial disparities in areas of surgery, trauma, opioid prescription and usage, women’s health, and others. Racial disparities were mitigated in postoperative complications, trauma care, and cancer screenings but persisted in diabetes readmissions, opioid usage, and minimally invasive women’s health procedures. Conclusion Universal coverage mitigates many, but not all, racial disparities in health care. An examination of a broader range of interventions, a closer look at variation in care provided by civilian facilities, and a look at the quality of care by race provide further opportunities for research.

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Army Warrior Care Project (AWCP): Rationale and methods for a longitudinal study of behavioral health care in Army Warrior Transition Units using Military Health System data, FY2008–2015

International Journal of Methods in Psychiatric Research ◽

10.1002/mpr.1788 ◽

2019 ◽

Vol 28 (3) ◽

Author(s):

Nikki R. Wooten ◽

Jordan A. Brittingham ◽

Akhtar Hossain ◽

Laura A. Hopkins ◽

Nahid S. Sumi ◽

...

Keyword(s):

Health Care ◽

Longitudinal Study ◽

Health System ◽

Behavioral Health ◽

Behavioral Health Care ◽

Military Health System ◽

Military Health ◽

Care Project ◽

System Data ◽

Health System Data

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A Survey of Family Planning Training, Knowledge, and Practices Among Health Care Providers Within the Military Health System at Joint Base Lewis–McChord

Military Medicine ◽

10.1093/milmed/usy255 ◽

2018 ◽

Vol 184 (5-6) ◽

pp. e394-e399 ◽

Cited By ~ 1

Author(s):

Elizabeth I Deans ◽

Alison L Batig ◽

Sarah Cordes ◽

Alicia N Scribner ◽

Peter E Nielsen ◽

...

Keyword(s):

Health Care ◽

Family Planning ◽

Health System ◽

Health Care Providers ◽

Care Providers ◽

Military Health System ◽

Military Health ◽

The Military

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Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities

Journal of Patient Experience ◽

10.1177/2374373520925275 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1234-1240

Author(s):

Tara Trudnak Fowler ◽

Kimberley Marshall Aiyelawo ◽

Chantell Frazier ◽

Craig Holden ◽

Joseph Dorris

Keyword(s):

Health Care ◽

Prenatal Care ◽

Health System ◽

Care Program ◽

The United States ◽

Successful Implementation ◽

Military Health System ◽

Military Health ◽

Individual Care ◽

Enhanced Prenatal Care

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care ( p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care ( p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.

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