scholarly journals Commercial and public payer opioid analgesic prescribing policies: a case study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Cynthia L. Arfken ◽  
Victoria Tutag Lehr
Keyword(s):  
Confidence Intervals ◽  
Opioid Analgesic ◽  
Temporal Trends ◽  
Steady Increase ◽  
Annual Percent Change ◽  
The Public ◽  
New Policies ◽  
Public Payer ◽  
The Impact

Abstract Background One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. Methods Policies for seven large commercial payers and the public payer for 2012–2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups. Results Across the 7 years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions and prior authorizations were the most frequently implemented policy. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6, 61.6%). Conclusions The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices.

scholarly journals Commercial and public payer opioid analgesic prescribing policies: A case study

2021 ◽  
Author(s):  
Cynthia L Arfken ◽  
Victoria Tutag Lehr
Keyword(s):  
Confidence Intervals ◽  
Opioid Analgesic ◽  
Temporal Trends ◽  
Steady Increase ◽  
Annual Percent Change ◽  
The Public ◽  
New Policies ◽  
Public Payer ◽  
The Impact

Abstract Background: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. Methods: Policies for seven large commercial payers and the public payer for 2012-2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups. Results: Across the seven years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial and prior authorizations were the most frequently implemented policy.. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2%, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6%, 61.6%).Conclusions: The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices.

scholarly journals Commercial and public payer opioid analgesic prescribing policies: A case study

2020 ◽  
Author(s):  
Cynthia L Arfken ◽  
Victoria Tutag Lehr
Keyword(s):  
Confidence Intervals ◽  
Opioid Analgesic ◽  
Temporal Trends ◽  
Steady Increase ◽  
State Laws ◽  
The Public ◽  
New Policies ◽  
Public Payer ◽  
The Impact

Abstract Background: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. Between 2015 and 2018 claims paid by commercial payers dropped 30.5% and 15.2% for public payer, suggesting the impact of federal and state laws and regulations, media, advocacy groups, education, and payer policies. Methods: Policies for seven large commercial payers and the public payer for 2012-2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and commercial and public payer subgroups. Results: Across the seven years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions being most frequently implemented policy (83 policies and implemented at least once by all eight payers). The least frequently used policy was incentives to providers which was implemented once by one payer. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change=29.6% (95% confidence intervals 13.2%, 48.5%). The public payer (implemented 47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6%, 61.6%). Conclusions: The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented challenging clinicians providing patient care and researchers determining the impact. Key words : opioid prescribing, commercial insurance, public insurance, policies, regulations, temporal trends

scholarly journals Defining and Quantifying Intermittency in the Power Sector

Energies ◽  
2020 ◽  
Vol 13 (13) ◽  
pp. 3366
Author(s):  
Daniel Suchet ◽  
Adrien Jeantet ◽  
Thomas Elghozi ◽  
Zacharie Jehl
Keyword(s):  
Power Source ◽  
Production Data ◽  
Power Sector ◽  
Predictive Capacity ◽  
The Public ◽  
Current State ◽  
Definition Of ◽  
Quantitative Definition ◽  
The Impact

The lack of a systematic definition of intermittency in the power sector blurs the use of this term in the public debate: the same power source can be described as stable or intermittent, depending on the standpoint of the authors. This work tackles a quantitative definition of intermittency adapted to the power sector, linked to the nature of the source, and not to the current state of the energy mix or the production predictive capacity. A quantitative indicator is devised, discussed and graphically depicted. A case study is illustrated by the analysis of the 2018 production data in France and then developed further to evaluate the impact of two methods often considered to reduce intermittency: aggregation and complementarity between wind and solar productions.

scholarly journals Analisis Perubahan Persepsi Jamaah Dakwah Ustadz Evie Effendi Di Kota Bandung

2019 ◽  
Vol 19 (1) ◽  
pp. 51-62
Author(s):  
Nadhillah Kusindriani ◽  
Martha Tri Lestari
Keyword(s):  
Qualitative Approach ◽  
Case Study Method ◽  
Public Figure ◽  
The Public ◽  
The Impact ◽  
Research Show

Ustadz Evie Effendi was a public figure who is known by the public as a modern ustadz that use the Sundanese language when do Da’wah. The perceptions given by the society particularly of ustadz Evie Effendi Da'wah pilgrims are positive until ultimately ustadz Evie exposed "misinterpretation" case in August 2018 when he misinterpreted a verse in the Sura in the Quran. The occurrence of a case of "misinterpretation" had a significant impact for ustadz Evie Effendi, one of them is a lot of pilgrims from ustadz Evie Effendi in Bandung which is no longer a loyal following lectures activities conducted by him. The existence of the impact that occurs from the "misinterpretation" case encourages researchers to see how the changes in perception that occurred in ustadz Evie Effendi Da'wah worshipers in Bandung. This study used a qualitative approach through the case study method uses the concept of Yin (2015). The results of this research show that changes in perception that occurred in Ustadz Evie Effendi Da'wah worshipers in Bandung is different for adult ages (40 – 50 years) and adolescents (20 years) as well as temporary caused culture society Indonesia which is permissive.Ustadz Evie Effendi merupakan seorang publik figur yang dikenal oleh masyarakat sebagai ustadz kekinian yang menggunakan bahasa Sunda ketika ceramah. Persepsi yang diberikan masyarakat khususnya jamaah dakwah ustadz Evie Effendi positif sampai pada akhirnya ustadz Evie terkena kasus “salah tafsir” pada bulan Agustus 2018 ketika ia salah menfasirkan ayat dalam suatu surat di Al-Quran. Terjadinya kasus “salah tafsir” memberikan dampak yang cukup besar bagi ustadz Evie Effendi salah satunya adalah banyak dari jamaah dakwah ustadz Evie Effendi di Kota Bandung yang tidak lagi setia mengikuti kegiatan ceramah yang dilakukan ustadz Evie Effendi. Adanya dampak yang terjadi dari kasus “salah tafsir” mendorong peneliti untuk melihat bagaimana perubahan persepsi yang terjadi pada jamaah dakwah ustadz Evie Effendi di Kota Bandung. Penelitian ini menggunakan pendekatan kualitatif melalui metode studi kasus menggunakan konsep Yin (2015). Hasil penelitian ini menunjukkan bahwa perubahan persepsi yang terjadi pada jamaah dakwah ustadz Evie Effendi di Kota Bandung berbeda untuk kalangan usia dewasa (40 – 50 tahun) dan remaja (20 tahun) serta bersifat sementara yang disebabkan kultur masyarakat Indonesia yang permisif.

scholarly journals The Value of Ecological Plantings in Public Gardens

2009 ◽  
pp. 43-59
Author(s):  
Chris Flynn
Keyword(s):  
Vegetation Type ◽  
Educational Benefits ◽  
Public Gardens ◽  
The Public ◽  
South Wales ◽  
Potential Applications ◽  
Royal Botanic Gardens ◽  
Ecological Planting ◽  
The Impact

This paper has been developed from a third year dissertation written as part of the Diploma in Horticulture course at the Royal Botanic Gardens, Kew. It serves as an overview of the subject of ecological planting and its potential applications within public gardens. It also outlines some scientific benefits regarding ecological studies, the impact that this type of planting may have on horticulture (both in gardens and the nursery trade), and the educational benefits for the public and school groups. The case study below looks at the viability of representing a section of Snow Gum Grassy Woodland (a vegetation type found in New South Wales, Australia) outside in Coates Wood, Wakehurst Place, UK.

The Impact of Cutbacks From a Major State Financial Crisis on Organizational Trust

2021 ◽  
pp. 027507402110530
Author(s):  
Marco Tulio Zanini ◽  
Carmen Migueles ◽  
Juliana Carvalho
Keyword(s):  
Financial Crisis ◽  
Organizational Trust ◽  
Longitudinal Case Study ◽  
Public Servants ◽  
Negative Behaviors ◽  
The Public ◽  
Negative Effect ◽  
The Impact

Previous research has shown that cutbacks in public spending often impact the range and quality of the public services delivered, leading to negative behaviors on the part of public servants. This article examines how sudden cutbacks caused by a major state financial crisis have an impact on interpersonal trust within a special police unit. We present the results of a longitudinal case study using a combination of qualitative methods. The lack of foreseeability and reliability caused by drastic changes resulting from cutbacks has a negative effect on members’ trust in their capacity to perform.

Additional Opinions and Judicial Diversity at the International Court of Justice

2020 ◽  
pp. 246-262 ◽  
Author(s):  
Hemi Mistry
Keyword(s):  
Gender Diversity ◽  
Personal Characteristics ◽  
International Court Of Justice ◽  
The Public ◽  
Court Of Justice ◽  
International Court ◽  
The Public Sphere ◽  
The Individual ◽  
The Impact

Additional opinions—that is, dissenting opinions, separate opinions, and declarations—are, by definition, the primary institutional mechanism through which judges can express their individual views on a particular decision, as distinct from the judgment or decision proclaimed on behalf of the institution. Therefore, within the public sphere they are the principal institutional manifestation of the individual—and thus the individuality—of the judge. Consequently, for those who seek to understand the impact of certain personal characteristics upon how a judge discharges their professional functions and, in turn, the wider institutional and systemic implications of the participation of individuals bearing those characteristics, the study of additional opinions would seem a useful analytical enterprise. Using gender diversity at the International Court of Justice as a case study, the purpose of this chapter is twofold: first, to explain the relationship between diversity and additional opinions, and second, to explore the methodological potential, and challenges, that the study of additional opinions entails.

scholarly journals Citizen as Sensors' Commitment in Urban Public Action

2019 ◽  
Vol 8 (4) ◽  
pp. 42-59 ◽  
Author(s):  
Gwendoline l'Her ◽  
Myriam Servières ◽  
Daniel Siret
Keyword(s):  
Air Quality ◽  
Citizen Science ◽  
Urban Air Quality ◽  
Urban Air ◽  
The Public ◽  
Public Action ◽  
Quality Issue ◽  
Data Analyses ◽  
The Impact

Based on a case study in Rennes, the article presents how a group of urban public actors re-uses methods and technology from citizen sciences to raise the urban air quality issue in the public debate. The project gives a group of inhabitants the opportunity to follow air quality training and proceed PM2.5µm measurements. The authors question the impact of the ongoing hybridisation between citizen science and urban public action on participants' commitment. The authors present how the use of PM2.5-sensors during 11 weeks led to a disengagement phenomenon, even if the authors observe a strong participation to workshops. These results come from an interdisciplinary methodology using observations, interviews, and data analyses.

scholarly journals Overcoming the Challenges of Collaboratively Adopting Artificial Intelligence in the Public Sector

2020 ◽  
pp. 089443932097995
Author(s):  
Averill Campion ◽  
Mila Gasco-Hernandez ◽  
Slava Jankin Mikhaylov ◽  
Marc Esteve
Keyword(s):  
Artificial Intelligence ◽  
Data Sharing ◽  
Research University ◽  
Steady Increase ◽  
Organizational Routines ◽  
Privacy And Security ◽  
Collaborative Project ◽  
The Public ◽  
Interorganizational Collaborations

Despite the current popularity of artificial intelligence (AI) and a steady increase in publications over time, few studies have investigated AI in public contexts. As a result, assumptions about the drivers, challenges, and impacts of AI in government are far from conclusive. By using a case study that involves a large research university in England and two different county councils in a multiyear collaborative project around AI, we study the challenges that interorganizational collaborations face in adopting AI tools and implementing organizational routines to address them. Our findings reveal the most important challenges facing such collaborations: a resistance to sharing data due to privacy and security concerns, insufficient understanding of the required and available data, a lack of alignment between project interests and expectations around data sharing, and a lack of engagement across organizational hierarchy. Organizational routines capable of overcoming such challenges include working on-site, presenting the benefits of data sharing, reframing problems, designating joint appointments and boundary spanners, and connecting participants in the collaboration at all levels around project design and purpose.

scholarly journals Model analysis and simulation on impacts of COVID-19 pandemic on the economy: a case study of Thailand’s GDP and its lock down measures

2020 ◽  
Vol 14 ◽  
Keyword(s):  
Virus Infection ◽  
Difference Equations ◽  
Local Economy ◽  
Financial Impact ◽  
Linear Difference Equations ◽  
The Public ◽  
Growth Product ◽  
Global And Local ◽  
The Impact

COVID-19 could affect the global and local economy mainly by directly affecting production, by creation of disruption in supply chains and markets, as well as through its financial impact on firms and markets and organizations. However, the extent to which the impact is felt depends a great deal on the how governments and the public react to the disease. Here, a model is proposed to investigate the effect of the spread of corona virus infection and the consequent measures taken in response to its spread to lessen its impacts on the society and the economy. The interaction between the number of infected individuals and the variations in the national Growth Product, GDP, is modeled by a system of impulsive non-linear difference equations with delays. We are specifically interested in how different lock down measures effect business recovery as reflected by the national GDP. The model is analyzed to obtain valuable insights as to the factors that could yield different successes in the pandemic control and business recovery in various scenarios. Based on data of newly infected cases and cumulative cases weekly in Thailand, the model is simulated in a variety of scenarios to illustrate how different strategies and lockdown measures may give rise to different recovery rates.

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