Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross‐sectional study of a state all‐payer claims database

Abstract Background Nursing home residents have high medical care needs. Their medical care utilization is, however, lower compared to community-dwelling elderly and varies widely among nursing homes. This study quantified the utilization of general practitioners (GPs), dentists, and medical specialists among nursing homes and residents, and investigated whether dentist utilization is associated with individual and nursing home characteristics. Methods Forty-four nursing homes invited 2124 residents to participate in a cross-sectional study. For 10 medical specialties, data on contacts in nursing homes, practices, and by telephone in the last 12 months were assessed at individual and nursing home level. The proportion of nursing homes and residents with any form of contact, and the median number and interquartile range (IQR) of contacts among individuals with contact were determined. Using multilevel logistic regression, associations between the probability of individual dental care utilization and sex, age, LTC grade, years of residence, sponsorship, number of nursing home beds, and transport and medical escort services for consultations at a practice were investigated. Results The proportion of nursing homes with any form of contact with physicians ranged from 100% for GPs, dentists, and urologists to 76.7% for gynecologists and orthopedists. Among the nursing homes, 442 residents participated (20.8% response). The proportion of residents with any contact varied from 97.8% for GPs, 38.5% for neurologists/psychiatrists, and 32.3% for dentists to 3.0% for gynecologists. Only for GPs, neurologists/psychiatrists, dentists, otorhinolaryngologists, urologists, and dermatologists, the proportion was higher for nursing home contacts than for practice and telephone contacts. Among residents with any contact, the median number of contacts was highest for GPs (11.0 [IQR 7.0-16.0]), urologists (4.0 [IQR 2.0-7.0]), and neurologists/psychiatrists (3.0 [IQR 2.0-5.0]). Dentist utilization varied widely among nursing homes (median odds ratio 2.5) and was associated with higher age. Conclusions Almost all residents had regular contact to GPs, but only one third had contact with dentists. Lower proportions with contact were found for medical specialists, except for neurologists/psychiatrists. Reasons for the large variations in dental care utilization among nursing homes should be identified. Trial registration DRKS00012383 [2017/12/06].

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Hypogonadism in opioid using males in an inner-city cohort: A cross-sectional study

Journal of Opioid Management ◽

10.5055/jom.2021.0624 ◽

2021 ◽

Vol 17 (2) ◽

pp. 135-144

Author(s):

Leen Wehbeh, MD ◽

Adrian S. Dobs, MD, MHS ◽

Todd T. Brown, MD, PhD

Keyword(s):

Drug Users ◽

Free Testosterone ◽

Cross Sectional Study ◽

Opioid Use Disorder ◽

Male Hypogonadism ◽

Abdominal Adiposity ◽

Sectional Study ◽

Opioid Use ◽

Cross Sectional ◽

Heroin Use

Objectives: The link between male hypogonadism and opioids is well-established, but whether there is a difference in the frequency of hypogonadism between heroin and methadone for treatment of opioid use disorder (OUD) has not been determined.Design: Cross-sectional.Setting, patients, and participants: Male drug users and nonusers matched for socioeconomic status between 18 and 65 years, recruited in Baltimore as part of the study of HIV, injection drug use, nutrition, and endocrinology (SHINE). Methods: Hypogonadism was defined as low free testosterone 50 pg/mL. Participants were categorized into three groups based on opioid use: (1) NONE, (2) methadone use as treatment of OUD (METHADONE), and (3) Heroin use (HEROIN). This third group was further divided to mild (MH), and heavy (HH) heroin use. We used multiple logistic regression to examine the association between hypogonadism and different groups.Results: The cohort consisted of 189 men, 94 percent black, average age 43 years, with high HIV (56 percent) and HCV (38 percent) prevalence. 24 percent had hypogonadism. Compared to NONE, there were higher odds of hypogonadism in METHADONE (aOR 3.46; 95 percent CI [1.34,8.93]; p = 0.01) but not in HEROIN. After dividing HEROIN into MH and HH, there were higher odds of hypogonadism in HH compared to NONE (aOR 3.27; 95 percent CI [1.12,9.53]; p = 0.03) but not in MH.Conclusions: Methadone used for treatment of OUD was associated with male hypogonadism similar to heavy heroin use. Targeted hypogonadism screening and treatment may be warranted in this population to reduce its health consequences such as sexual dysfunction, osteoporosis, and abdominal adiposity.

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Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101691 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1691

Author(s):

Elena Rodriguez-Alvarez ◽

Nerea Lanborena ◽

Luisa N. Borrell

Keyword(s):

Economic Crisis ◽

Dental Care ◽

Cross Sectional Study ◽

Place Of Birth ◽

Sectional Study ◽

Dental Services ◽

Cross Sectional ◽

Care Services ◽

Binomial Regression ◽

Before And After

This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10–1.67) and Africa (PR: 1.16, 95% CI: 1.05–1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46–2.01) and Asia (PR: 1.3, 95% CI: 1.23–1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.

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Organ pathologies detected post‐mortem in patients receiving opioid agonist treatment for opioid use disorder: a nationwide 2‐year cross‐sectional study

Addiction ◽

10.1111/add.15705 ◽

2021 ◽

Author(s):

Anne Berit Bech ◽

Thomas Clausen ◽

Helge Waal ◽

Gerd Jorunn Møller Delaveris ◽

Ivar Skeie

Keyword(s):

Cross Sectional Study ◽

Opioid Use Disorder ◽

Post Mortem ◽

Sectional Study ◽

Opioid Use ◽

Opioid Agonist ◽

Cross Sectional ◽

Opioid Agonist Treatment

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Buprenorphine use and disparities in access among emergency department patients with opioid use disorder: A cross-sectional study

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2021.108405 ◽

2021 ◽

Vol 130 ◽

pp. 108405

Author(s):

Matthew Robbins ◽

Rachel Haroz ◽

Anthony Mazzarelli ◽

David Clements ◽

Christopher W. Jones ◽

...

Keyword(s):

Emergency Department ◽

Cross Sectional Study ◽

Opioid Use Disorder ◽

Sectional Study ◽

Opioid Use ◽

Cross Sectional ◽

Emergency Department Patients

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Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2019.107612 ◽

2019 ◽

Vol 205 ◽

pp. 107612 ◽

Cited By ~ 9

Author(s):

Hilary S. Connery ◽

Nadine Taghian ◽

Jungjin Kim ◽

Margaret Griffin ◽

Ian R.H. Rockett ◽

...

Keyword(s):

Cross Sectional Study ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Sectional Study ◽

Opioid Use ◽

Cross Sectional

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Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study

PLoS Medicine ◽

10.1371/journal.pmed.1002941 ◽

2019 ◽

Vol 16 (11) ◽

pp. e1002941 ◽

Cited By ~ 3

Author(s):

Yu-Jung Jenny Wei ◽

Cheng Chen ◽

Roger Fillingim ◽

Siegfried O. Schmidt ◽

Almut G. Winterstein

Keyword(s):

Cross Sectional Study ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Sectional Study ◽

Opioid Use ◽

Cross Sectional ◽

Prescription Opioid Use

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Understanding current practice of opioid use disorder management in emergency departments across Canada: A cross-sectional study

CJEM ◽

10.1017/cem.2020.362 ◽

2020 ◽

Vol 22 (4) ◽

pp. 494-498

Author(s):

Patricia Hoyeck ◽

David Wiercigroch ◽

Cara Clarke ◽

Rahim Moineddin ◽

Hasan Sheikh ◽

...

Keyword(s):

Emergency Departments ◽

Management Practices ◽

Cross Sectional Study ◽

Opioid Use Disorder ◽

Emergency Physicians ◽

Sectional Study ◽

Opioid Use ◽

Current Management ◽

Cross Sectional ◽

Canadian Association

ABSTRACTObjectiveOpioid-related deaths are increasing at alarming rates in Canada, with a 34% increase from 2016 to 2017. Patients with opioid use disorder often visit emergency departments (ED), presenting an opportunity to engage patients in treatment. Buprenorphine-naloxone is first-line treatment for opioid use disorder, but current management in the ED is unknown. This study aimed to characterize opioid use disorder management in the ED.MethodsWe conducted a cross-sectional study of emergency physicians across Canada. A survey was circulated electronically to the Canadian Association of Emergency Physicians members. Participants were asked about their current management practices, satisfaction, and helpfulness of resources. SAS (version 9.4) was used for statistical analysis. We dichotomized Likert-scale responses to approximate relative risk ratios via a log binomial analysis.ResultsThe survey was completed by 179 participants for a response rate of 11.1%; 143 (79.9%) physicians treated patients with opioid use disorder more than once a week. Only 7% (n = 13) of respondents always/often gave buprenorphine in the ED. Referral to an addiction clinic where patients were seen quickly was deemed the most helpful (90.5%, n = 162). Physicians who reported satisfaction with opioid use disorder management were four times more likely to prescribe buprenorphine in the ED or as an outpatient script (RR = 4.41, CI = 2.33–8.33, p < 0.01; RR = 4.51, CI = 2.21–9.22, p < 0.01).ConclusionThis study found that buprenorphine is not frequently prescribed in the ED setting, which is incongruent with the 2018 guidelines. Care coordination and on-site support were helpful to ED physicians. Hospitals should use knowledge translation strategies to improve the care of patients with an opioid use disorder.

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