scholarly journals Decline in prenatal buprenorphine/naloxone fills during the COVID-19 pandemic in the United States

2021 ◽  
Author(s):  
Ashley L O'Donoghue ◽  
Alyse Reichheld ◽  
Timothy S Anderson ◽  
Chloe A Zera ◽  
Tenzin Dechen ◽  
...  
Keyword(s):  
Growth Rate ◽  
Claims Data ◽  
Interrupted Time Series ◽  
The United States ◽  
Medical Claims ◽  
Pregnancy Care ◽  
Pharmacy Claims ◽  
Positive Growth ◽  
Number Of Individuals ◽  
Naloxone Treatment

Background and Aims: Pregnancy provides a critical opportunity to engage women with substance use disorder in care. Buprenorphine/naloxone treatment is associated with improved pregnancy and fetal outcomes, but prior to the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these already existing barriers. To quantify these changes, we examined trends in the number of individuals filling prescriptions for prenatal buprenorphine/naloxone prescriptions during the COVID-19 pandemic. Methods: We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from May 2019 to December 2020. We estimated changes in the level and trend in the monthly number of individuals filling prescriptions for prenatal buprenorphine/naloxone during the COVID-19 pandemic. We then stratified our analyses by payer. Results: We identified 2,947 pregnant patients filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling prescriptions for prenatal buprenorphine/naloxone (4.83% (95% confidence interval (CI): 3.40% to 6.26%). During the pandemic, the monthly growth rate in individuals filling prescriptions for prenatal buprenorphine/naloxone declined for both patients on commercial insurance and patients on Medicaid (all payers: -5.53% (95% CI: -7.28% to -3.78%); Medicaid: -7.66% (95% CI: -10.42% to -4.90%); Commercial: -3.59% (95% CI: -5.53% to -1.66%)). Conclusion: The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing prior to the pandemic, but this growth has been lost during the pandemic.

scholarly journals COVID‐19 and Anticoagulation for Atrial Fibrillation: An Analysis of US Nationwide Pharmacy Claims Data

2021 ◽  
Author(s):  
Inmaculada Hernandez ◽  
Nico Gabriel ◽  
Meiqi He ◽  
Jingchuan Guo ◽  
Mina Tadrous ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Claims Data ◽  
Interrupted Time Series ◽  
World Health ◽  
Medicare Beneficiaries ◽  
Excess Supply ◽  
Pharmacy Claims ◽  
Time Series Analyses ◽  
Nationally Representative ◽  
Health Organization

Background Adherence to oral anticoagulation (OAC) is critical for stroke prevention in atrial fibrillation. However, the COVID‐19 pandemic may have disrupted access to such therapy. We hypothesized that our analysis of a US nationally representative pharmacy claims database would identify increased incidence of lapses in OAC refills during the COVID‐19 pandemic. Methods and Results We identified individuals with atrial fibrillation prescribed OAC in 2018. We used pharmacy dispensing records to determine the incidence of 7‐day OAC gaps and 15‐day excess supply for each 30‐day interval from January 1, 2019 to July 8, 2020. We constructed interrupted time series analyses to test changes in gaps and supply around the pandemic declaration by the World Health Organization (March 11, 2020), and whether such changes differed by medication (warfarin or direct OAC), prescription payment type, or prescriber specialty. We identified 1 301 074 individuals (47.5% women; 54% age ≥75 years). Immediately following the COVID‐19 pandemic declaration, we observed a 14% decrease in 7‐day OAC gaps and 56% increase in 15‐day excess supply (both P <0.001). The increase in 15‐day excess supply was more marked for direct OAC (69% increase) than warfarin users (35%; P <0.001); Medicare beneficiaries (62%) than those with commercial insurance (43%; P <0.001); and those prescribed OAC by a cardiologist (64%) rather than a primary care provider (48%; P <0.001). Conclusions Our analysis of nationwide claims data demonstrated increased OAC possession after the onset of the COVID‐19 pandemic. Our findings may have been driven by waivers of early refill limits and patients’ tendency to stockpile medications in the first weeks of the pandemic.

scholarly journals Assessing the distribution and drivers of vaccine hesitancy using medical claims data

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Sandra Goldlust ◽  
Elizabeth Lee ◽  
Shweta Bansal
Keyword(s):  
United States ◽  
Claims Data ◽  
The United States ◽  
Vaccine Uptake ◽  
Vaccine Hesitancy ◽  
Modeling Framework ◽  
Medical Claims ◽  
Vaccine Refusal ◽  
The Social ◽  
Disparate Data

ObjectiveThe purpose of this study was to investigate the use of large-scalemedical claims data for local surveillance of under-immunizationfor childhood infections in the United States, to develop a statisticalframework for integrating disparate data sources on surveillance ofvaccination behavior, and to identify the determinants of vaccinehesitancy behavior.IntroductionIn the United States, surveillance of vaccine uptake for childhoodinfections is limited in scope and spatial resolution. The NationalImmunization Survey (NIS) - the gold standard tool for monitoringvaccine uptake among children aged 19-35 months - is typicallyconstrained to producing coarse state-level estimates.1In recent years,vaccine hesitancy (i.e., a desire to delay or refuse vaccination, despiteavailability of vaccination services)2has resurged in the United States,challenging the maintenance of herd immunity. In December 2014,foreign importation of the measles virus to Disney theme parks inOrange County, California resulted in an outbreak of 111 measlescases, 45% of which were among unvaccinated individuals.3Digitalhealth data offer new opportunities to study the social determinantsof vaccine hesitancy in the United States and identify finer spatialresolution clusters of under-immunization using data with greaterclinical accuracy and rationale for hesitancy.4MethodsOur U.S. medical claims data comprised monthly reports ofdiagnosis codes for under-immunization and vaccine refusal(Figure 1). These claims were aggregated to five-digit zip-codes bypatient age-group from 2012 to 2015. Spatial generalized linear mixedmodels were used to generate county-level maps for surveillanceof under-immunization and to identify the determinants of vaccinehesitancy, such as income, education, household size, religious grouprepresentation, and healthcare access. We developed a Bayesianmodeling framework that separates the observation of vaccinehesitancy in our data from true underlying rates of vaccine hesitancyin the community. Our model structure also enabled us to borrowinformation from neighboring counties, which improves predictionof vaccine hesitancy in areas with missing or minimal data. Estimatesof the posterior distributions of model parameters were generated viaMarkov chain Monte Carlo (MCMC) methods.ResultsOur modeling framework enabled the production of county-levelmaps of under-immunization and vaccine refusal in the UnitedStates between 2012-2015, the identification of geographic clustersof under-immunization, and the quantification of the associationbetween various epidemiological factors and vaccination status.In addition, we found that our model structure enabled us to accountfor spatial variation in reporting vaccine hesitancy, which improvedour estimation.ConclusionsOur work demonstrate the utility of using large-scale medicalclaims data to improve surveillance systems for vaccine uptake andto assess the social and ecological determinants of vaccine hesitancy.We describe a flexible, hierarchical modeling framework forintegrating disparate data sources, particularly for data collectedthrough different measurement processes or at different spatial scales.Our findings will enhance our understanding of the causes of under-immunization, inform the design of vaccination policy, and aid inthe development of targeted public health strategies for optimizingvaccine uptake.Figure 1. Instances of vaccine refusal (per 100,000 population) for UnitedStates counties in 2014 as observed in medical claims data.

The United States as the Trade Partner of Poland in te Context of the Transatlantic Trade and Investment Partnership (TTIP)

2014 ◽  
Vol 9 (3) ◽  
pp. 201-213
Author(s):  
Renata Marks-Bielska ◽  
Wiesława Lizińska ◽  
Izabela Serocka
Keyword(s):  
Growth Rate ◽  
Foreign Trade ◽  
The United States ◽  
Average Growth ◽  
Transatlantic Trade ◽  
Central Statistical ◽  
The Usa ◽  
Central Statistical Office ◽  
Trade Partner ◽  
Structure Of Trade

Evaluation of the importance of the USA as the trade partner of Poland is the main objective of the paper, based on the changes in the value of trade during the years 2000-2012 and changes in the structure of trade during the years 2008-2012. The data from the Statistical Yearbooks of Foreign Trade published by the Central Statistical Office was used. The potential for foreign trade growth was illustrated using the simplified analysis based on the gravity model of foreign trade concept. Gradually increasing value of Polish trade with the USA (the average growth rate 9.8%, EU-15 countries 13.1%). Polish exports are characterised by a higher than imports growth rate (USA - exports growth by 12.5%, imports 9.2%, EU-15 - exports 15.1%, imports 11.6%). Trade is strongly dominated by position of one group of products (over 30% share in both exports and imports). The potential of trade is poorly exploited currently. Trade was focused mainly on the countries situated in the close neighbourhood (mainly the EU countries with the domination of Germany).

scholarly journals Public Compliance With Social Distancing Measures and SARS-CoV-2 Spread

2021 ◽  
pp. 003335492110112
Author(s):  
Hongjie Liu ◽  
Chang Chen ◽  
Raul Cruz-Cano ◽  
Jennifer L. Guida ◽  
Minha Lee
Keyword(s):  
Growth Rate ◽  
Reproduction Number ◽  
Early Stage ◽  
Human Mobility ◽  
The United States ◽  
Density Change ◽  
Regression Coefficients ◽  
Daily Growth Rate ◽  
Daily Growth ◽  
Social Distancing

Objective We quantified the association between public compliance with social distancing measures and the spread of SARS-CoV-2 during the first wave of the epidemic (March–May 2020) in 5 states that accounted for half of the total number of COVID-19 cases in the United States. Methods We used data on mobility and number of COVID-19 cases to longitudinally estimate associations between public compliance, as measured by human mobility, and the daily reproduction number and daily growth rate during the first wave of the COVID-19 epidemic in California, Illinois, Massachusetts, New Jersey, and New York. Results The 5 states mandated social distancing directives during March 19-24, 2020, and public compliance with mandates started to decrease in mid-April 2020. As of May 31, 2020, the daily reproduction number decreased from 2.41-5.21 to 0.72-1.19, and the daily growth rate decreased from 0.22-0.77 to –0.04 to 0.05 in the 5 states. The level of public compliance, as measured by the social distancing index (SDI) and daily encounter-density change, was high at the early stage of implementation but decreased in the 5 states. The SDI was negatively associated with the daily reproduction number (regression coefficients range, –0.04 to –0.01) and the daily growth rate (from –0.009 to –0.01). The daily encounter-density change was positively associated with the daily reproduction number (regression coefficients range, 0.24 to 1.02) and the daily growth rate (from 0.05 to 0.26). Conclusions Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits.

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

2021 ◽  
pp. 1-7
Author(s):  
Bethany A. Wattles ◽  
Kahir S. Jawad ◽  
Yana Feygin ◽  
Maiying Kong ◽  
Navjyot K. Vidwan ◽  
...  
Keyword(s):  
Claims Data ◽  
Inappropriate Prescribing ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Pharmacy Claims ◽  
Medicaid Children

Abstract Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

scholarly journals SARS-CoV-2 Serologic Assay Needs for The Next Phase of U.S. COVID-19 Pandemic Response

2020 ◽  
Author(s):  
Adi V Gundlapalli ◽  
Reynolds M Salerno ◽  
John T Brooks ◽  
Francisco Averhoff ◽  
Lyle Petersen ◽  
...  
Keyword(s):  
English Language ◽  
The United States ◽  
Humoral Immune ◽  
Humoral Immune Responses ◽  
Literature Searches ◽  
Quantitative Results ◽  
Pandemic Response ◽  
Meta Analyses ◽  
Antibody Kinetics ◽  
Number Of Individuals

Abstract Background There is a need for validated and standardized SARS-CoV-2 quantitative IgG and neutralization assays that can be used to understand the immunology and pathogenesis of SARS-CoV-2 infection and support the COVID-19 pandemic response. Methods Literature searches were conducted to identify English language publications from peer-reviewed journals and pre-prints from January 2020 through October 12, 2020. Relevant publications were reviewed for mention of IgG or neutralization assays for SARS-CoV-2, or both, and the methods of reporting assay results. Results Quantitative SARS-CoV-2 IgG results have been reported from a limited number of studies; most studies used in-house laboratory-developed tests in limited settings, and only two semi-quantitative tests have received U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA). As of October12, 2020, there are no neutralization assays with FDA EUA. Relatively few studies have attempted correlation of quantitative IgG titers with neutralization results to estimate surrogates of protection. The number of individuals tested is small compared to the magnitude of the pandemic and persons tested are not representative of disproportionately affected populations. Methods of reporting quantitative results are not standardized to enable comparisons and meta-analyses. Conclusions Lack of standardized SARS-CoV-2 quantitative IgG and neutralization assays precludes comparison of results from published studies. Inter-assay and inter-laboratory validation and standardization of assays will support efforts to better understand antibody kinetics and longevity of humoral immune responses post-illness, surrogates of immune protection, and vaccine immunogenicity and efficacy. Public-private partnerships could facilitate realization of these advances in the United States and world-wide.

Importance of Behavioral and Psychological Symptoms of Dementia in Primary Care

2000 ◽  
Vol 12 (S1) ◽  
pp. 67-72 ◽  
Author(s):  
William H. Coleman
Keyword(s):  
United States ◽  
Primary Care ◽  
Psychological Distress ◽  
Direct Relationship ◽  
Psychological Symptoms ◽  
The United States ◽  
Comprehensive Treatment ◽  
The Cost ◽  
Number Of Individuals ◽  
Behavioral And Psychological Symptoms

There is a direct relationship between years lived beyond age 65 and the number of individuals diagnosed with dementia, primarily Alzheimer's disease (AD). The occurrence of AD has no socioeconomic, geographical, or ethnic limitations. The problem is worldwide. Its magnitude is demonstrated by the following facts: (a) approximately 6% to 8% of persons 65 years or older have AD, and the prevalence of the disease doubles each 5 years after 60 years of age; (b) 30% of 85-year-old individuals can be expected to have the disease; (c) AD affects an estimated 4 million people in the United States, and is expected to affect approximately 14 million Americans within the next few decades; (d) AD patients average 6 to 10 years of comprehensive treatment from symptom onset to death; (e) AD is the fourth leading cause of mortality among elderly Americans, more than 100,000 each year; (f) caregiver attempts at management of the behavioral and psychological symptoms of AD result in up to 50% developing significant psychological distress themselves; and (g) the cost for the management of AD patients is estimated to be between US $80 billion and US $120 billion annually. Primary care is essential for the appropriate diagnosis and treatment of the complex set of behavioral and psychological symptoms of dementia (BPSD) associated with AD.

Trends in the utilisation of lipid-lowering medications in Australia: an analysis of national pharmacy claims data

2021 ◽  
pp. 100880
Author(s):  
Stella Talica ◽  
Clara Marquina Hernandez ◽  
Richard Ofori-Asenso ◽  
Danny Liew ◽  
Alice Owen ◽  
...  
Keyword(s):  
Claims Data ◽  
Lipid Lowering ◽  
Pharmacy Claims

Probation officer discretion in monitoring and violating supervision conditions

2021 ◽  
pp. 026455052110415
Author(s):  
Ebony Ruhland ◽  
Esther Scheibler
Keyword(s):  
United States ◽  
Decision Making ◽  
Qualitative Data ◽  
The United States ◽  
Probation Officer ◽  
Probation Officers ◽  
Number Of Individuals

Probation is a sentence served in the community and includes a number of supervision conditions. If the conditions are violated, individuals could receive a sanction, including revocation. Not every violation, however, may receive a consequence. Probation officers have discretion for how they manage individuals on the caseloads. This study used qualitative data from two departments in a MidWest state in the United States, one rural and one urban, to explore officer decision-making in supervision. It is critical to examine these factors due to the high number of individuals revoked from probation each year. The study findings illustrate the factors officers use in monitoring conditions, as well as in violations and revocations.

Sign in / Sign up

Export Citation Format

Share Document