scholarly journals Predictors of Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement among patients with opioid use disorder across 7 health systems

2019 ◽  
Vol 40 (3) ◽  
pp. 328-334 ◽  
Author(s):  
Cynthia I. Campbell ◽  
Constance Weisner ◽  
Ingrid A. Binswanger ◽  
Gwen T. Lapham ◽  
Brian K. Ahmedani ◽  
...  
Keyword(s):  
Health Systems ◽  
Treatment Initiation ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Information Set ◽  
Effectiveness Data

scholarly journals A machine learning based two-stage clinical decision support system for predicting patients’ discontinuation from opioid use disorder treatment: retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Md Mahmudul Hasan ◽  
Gary J. Young ◽  
Jiesheng Shi ◽  
Prathamesh Mohite ◽  
Leonard D. Young ◽  
...  
Keyword(s):  
Machine Learning ◽  
Treatment Initiation ◽  
Clinical Decision ◽  
Opioid Use Disorder ◽  
Treatment Discontinuation ◽  
Discriminative Power ◽  
Opioid Use ◽  
Stage Models ◽  
C Statistic ◽  
One Year

Abstract Background Buprenorphine is a widely used treatment option for patients with opioid use disorder (OUD). Premature discontinuation from this treatment has many negative health and societal consequences. Objective To develop and evaluate a machine learning based two-stage clinical decision-making framework for predicting which patients will discontinue OUD treatment within less than a year. The proposed framework performs such prediction in two stages: (i) at the time of initiating the treatment, and (ii) after two/three months following treatment initiation. Methods For this retrospective observational analysis, we utilized Massachusetts All Payer Claims Data (MA APCD) from the year 2013 to 2015. Study sample included 5190 patients who were commercially insured, initiated buprenorphine treatment between January and December 2014, and did not have any buprenorphine prescription at least one year prior to the date of treatment initiation in 2014. Treatment discontinuation was defined as at least two consecutive months without a prescription for buprenorphine. Six machine learning models (i.e., logistic regression, decision tree, random forest, extreme-gradient boosting, support vector machine, and artificial neural network) were tested using a five-fold cross validation on the input data. The first-stage models used patients’ demographic information. The second-stage models included information on medication adherence during the early phase of treatment based on the proportion of days covered (PDC) measure. Results A substantial percentage of patients (48.7%) who started on buprenorphine discontinued the treatment within one year. The area under receiving operating characteristic curve (C-statistic) for the first stage models varied within a range of 0.55 to 0.59. The inclusion of knowledge regarding patients’ adherence at the early treatment phase in terms of two-months and three-months PDC resulted in a statistically significant increase in the models’ discriminative power (p-value < 0.001) based on the C-statistic. We also constructed interpretable decision classification rules using the decision tree model. Conclusion Machine learning models can predict which patients are most at-risk of premature treatment discontinuation with reasonable discriminative power. The proposed machine learning framework can be used as a tool to help inform a clinical decision support system following further validation. This can potentially help prescribers allocate limited healthcare resources optimally among different groups of patients based on their vulnerability to treatment discontinuation and design personalized support systems for improving patients’ long-term adherence to OUD treatment.

scholarly journals The prevalence of Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment among patients with cannabis use disorders in 7 US health systems

2019 ◽  
Vol 40 (3) ◽  
pp. 268-277
Author(s):  
Gwen T. Lapham ◽  
Cynthia I. Campbell ◽  
Bobbi Jo H. Yarborough ◽  
Rulin C. Hechter ◽  
Brian K. Ahmedani ◽  
...  
Keyword(s):  
Health Systems ◽  
Cannabis Use ◽  
Information Set ◽  
Cannabis Use Disorders ◽  
Engagement In Treatment ◽  
Effectiveness Data

scholarly journals Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sarah M. Bagley ◽  
Laura Chavez ◽  
Jordan M. Braciszewski ◽  
Mary Akolsile ◽  
Denise M. Boudreau ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Substance Use ◽  
Health Systems ◽  
Substance Use Disorders ◽  
Mental Health Disorders ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Medication Treatment ◽  
Health Disorders

Abstract Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

scholarly journals Documented opioid use disorder and its treatment in primary care patients across six U.S. health systems

2020 ◽  
Vol 112 ◽  
pp. 41-48 ◽  
Author(s):  
Denise M. Boudreau ◽  
Gwen Lapham ◽  
Eric A. Johnson ◽  
Jennifer F. Bobb ◽  
Abigail G. Matthews ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Primary Care Patients

scholarly journals Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rita Henderson ◽  
Ashley McInnes ◽  
Leslee Mackey ◽  
Myles Bruised Head ◽  
Lindsay Crowshoe ◽  
...  
Keyword(s):  
Public Health ◽  
Substance Use ◽  
Health Systems ◽  
Scoping Review ◽  
Scientific Journal ◽  
Grey Literature ◽  
Opioid Use Disorder ◽  
Nominal Group ◽  
Opioid Use ◽  
Public Health Emergencies

Abstract Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD.

Successful rotation from long-acting full agonist opioids to sublingual buprenorphine/naloxone using a microdosing approach

2021 ◽  
Vol 17 (7) ◽  
pp. 159-166
Author(s):  
René C. Vytialingam, MBBS, FRACGP, FAChAM ◽  
Stephan A. Schug, MD, FANZCA, FFPMANZCA, EDPM ◽  
Richard O’Regan, MBBS, FAChAM
Keyword(s):  
Treatment Initiation ◽  
Treatment Guidelines ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
First Line ◽  
Precipitated Withdrawal ◽  
Potential Barriers ◽  
Successful Induction ◽  
Potential Benefits ◽  
Long Acting

Buprenorphine/naloxone (BPN/NX) is a first-line treatment for opioid use disorder. Conventional treatment guidelines recommend a period of opioid abstinence and the presence of moderate withdrawal before initiation to avoid precipitated withdrawal. A newer approach of “microdosing” removes this requirement and has potential benefits. We present two cases of successful induction of BPN/NX using a microdosing regimen in an inpatient withdrawal unit. Both cases did not result in precipitated withdrawal and did not necessitate prior cessation of other opioids. This case report highlights how the use of microdosing to induct BPN/NX treatment can reduce potential barriers and complications with treatment initiation.

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