Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees

Objective: To identify sociodemographic profiles of patients prescribed high-dose opioids.Design: Cross-sectional cohort study.Setting/Patients: Veterans dually-enrolled in Veterans Health Administration and Medicare Part D, with ≥1 opioid prescription in 2012.Main Outcome Measures: We identified five patient-level demographic characteristics and 12 community variables reflective of region, socioeconomic deprivation, safety, and internet connectivity. Our outcome was the proportion of veterans receiving 120 morphine milligram equivalents (MME) for ≥90 consecutive days, a Pharmacy Quality Alliance measure of chronic high-dose opioid prescribing. We used classification and regression tree (CART) methods to identify risk of chronic high-dose opioid prescribing for sociodemographic subgroups.Results: Overall, 17,271 (3.3 percent) of 525,716 dually enrolled veterans were prescribed chronic high-dose opioids. CART analyses identified 35 subgroups using four sociodemographic and five community-level measures, with high-dose opioid prescribing ranging from 0.28 percent to 12.1 percent. The subgroup (n = 16,302) with highest frequency of the outcome included veterans who were with disability, age 18-64 years, white or other race, and lived in the Western Census region. The subgroup (n = 14,835) with the lowest frequency of the outcome included veterans who were without disability, did not receive Medicare Part D Low Income Subsidy, were 85 years old, and lived in communities within the second and sixth to tenth deciles of community public assistance.Conclusions: Using CART analyses with sociodemographic and community-level variables only, we identified subgroups of veterans with a 43-fold difference in chronic high-dose opioid prescriptions. Interactions among disability, age, race/ ethnicity, and region should be considered when identifying high-risk subgroups in large populations.

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Impact of Laws Regulating Pain Clinics on Opioid Prescribing and Opioid-Related Toxicity Among Texas Medicare Part D Beneficiaries

Journal of Pharmacy Technology ◽

10.1177/8755122516686226 ◽

2017 ◽

Vol 33 (2) ◽

pp. 60-65 ◽

Cited By ~ 7

Author(s):

Mukaila A. Raji ◽

Yong-Fang Kuo ◽

Nai-Wei Chen ◽

Hunaid Hasan ◽

Denise M. Wilkes ◽

...

Keyword(s):

Temporal Trends ◽

Medicare Part D ◽

Medicare Part ◽

Opioid Overdose ◽

Opioid Prescription ◽

Part D ◽

Opioid Prescribing ◽

Pain Clinics ◽

The Impact ◽

Over Time

Background: Pain management clinics are major sources of prescription opioids. Texas government passed several laws regulating pain clinics between 2009 and 2011 to reduce opioid-related toxicity. Understanding the impact of these laws can inform policy geared toward making the laws more effective in curbing the growing epidemic of opioid overdose, especially among the elderly population. Objectives: To examine the longitudinal association of laws regulating pain clinics on opioid-prescribing and opioid-related toxicity among Texas Medicare recipients. Methods: The 2007 to 2012 claims data for Texas Medicare Part D recipients were used to assess temporal trends in the percentage of patients filling any schedule II or schedule III opioid prescription, hospitalization for opioid toxicity, and their relationships to the 2009 to 2011 Texas laws regulating pain clinics. We excluded those with a cancer diagnosis. Join-point trend analysis with Bayesian Information Criterion selection methods were used to evaluate the change in monthly percentages of patients filling opioid prescriptions and hospitalization over time. Results: There was a short-lived decline in the monthly percentages of patients who filled a schedule II or schedule III opioid prescription after the 2009 laws regulating pain clinics. The decline lasted about 3 months. Subsequent new laws had no effect on the percentages of patients who filled any opioid prescription or were hospitalized for potential opioid toxicity. Hospitalizations for opioid toxicity were highest in the winter and lowest in the summer. Conclusions: Changes in the percentages of opioid-prescribing or opioid-related hospitalizations over time were not associated with laws regulating pain clinics.

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Opioid Prescribing to Medicare Part D Enrollees, 2013–2017: Shifting Responsibility to Pain Management Providers

Pain Medicine ◽

10.1093/pm/pnz344 ◽

2020 ◽

Vol 21 (7) ◽

pp. 1400-1407 ◽

Cited By ~ 1

Author(s):

Adam N Romman ◽

Connie M Hsu ◽

Lin-Na Chou ◽

Yong-Fang Kuo ◽

Rene Przkora ◽

...

Keyword(s):

Pain Management ◽

Medicare Part D ◽

Medical Specialty ◽

Medicare Part ◽

Provider Type ◽

Cross Sectional ◽

Part D ◽

Opioid Prescribing ◽

Prescribing Trends ◽

Level Analysis

Abstract Objective To examine opioid prescribing frequency and trends to Medicare Part D enrollees from 2013 to 2017 by medical specialty and provider type. Methods We conducted a retrospective, cross-sectional, specialty- and provider-level analysis of Medicare Part D prescriber data for opioid claims from 2013 to 2017. We analyzed opioid claims and prescribing trends for specialties accounting for ≥1% of all opioid claims. Results From 2013 to 2017, pain management providers increased Medicare Part D opioid claims by 27.3% to 1,140 mean claims per provider in 2017; physical medicine and rehabilitation providers increased opioid claims 16.9% to 511 mean claims per provider in 2017. Every other medical specialty decreased opioid claims over this period, with emergency medicine (–19.9%) and orthopedic surgery (–16.0%) dropping opioid claims more than any specialty. Physicians overall decreased opioid claims per provider by –5.2%. Meanwhile, opioid claims among both dentists (+5.6%) and nonphysician providers (+10.2%) increased during this period. Conclusions From 2013 to 2017, pain management and PMR increased opioid claims to Medicare Part D enrollees, whereas physicians in every other specialty decreased opioid prescribing. Dentists and nonphysician providers also increased opioid prescribing. Overall, opioid claims to Medicare Part D enrollees decreased and continue to drop at faster rates.

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Characteristics of Opioid Prescriptions to Veterans With Chronic Gastrointestinal Symptoms and Disorders Dually Enrolled in the Department of Veterans Affairs and Medicare Part D

Military Medicine ◽

10.1093/milmed/usab095 ◽

2021 ◽

Author(s):

Salva N Balbale ◽

Lishan Cao ◽

Itishree Trivedi ◽

Jonah J Stulberg ◽

Katie J Suda ◽

...

Keyword(s):

Gastrointestinal Symptoms ◽

Medicare Part D ◽

Medicare Part ◽

Opioid Use ◽

Opioid Prescription ◽

Part D ◽

Gi Symptoms ◽

Chronic Opioid Use ◽

Multiple Logistic Regression Modeling ◽

Chronic Use

ABSTRACT Introduction Gastrointestinal (GI) symptoms and disorders affect an increasingly large group of veterans. Opioid use may be rising in this population, but this is concerning from a patient safety perspective, given the risk of dependence and lack of evidence supporting opioid use to manage chronic pain. We examined the characteristics of opioid prescriptions and factors associated with chronic opioid use among chronic GI patients dually enrolled in the DVA and Medicare Part D. Materials and Methods In this retrospective cohort study, we used linked, national patient-level data (from April 1, 2011, to December 31, 2014) from the VA and Centers for Medicare & Medicaid Services to identify chronic GI patients and observe opioid use. Veterans who had a chronic GI symptom or disorder were dually enrolled in VA and Part D and received ≥1 opioid prescription dispensed through the VA, Part D, or both. Chronic GI symptoms and disorders included chronic abdominal pain, chronic pancreatitis, inflammatory bowel diseases, and functional GI disorders. Key outcome measures were outpatient opioid prescription dispensing overall and chronic opioid use, defined as ≥90 consecutive days of opioid receipt over 12 months. We described patient characteristics and opioid use measures using descriptive statistics. Using multiple logistic regression modeling, we generated adjusted odds ratios and 95% CIs to determine variables independently associated with chronic opioid use. The final model included variables outlined in the literature and our conceptual framework. Results We identified 141,805 veterans who had a chronic GI symptom or disorder, were dually enrolled in VA and Part D, and received ≥1 opioid prescription dispensed from the VA, Part D, or both. Twenty-six percent received opioids from the VA only, 69% received opioids from Medicare Part D only, and 5% were “dual users,” receiving opioids through both VA and Part D. Compared to veterans who received opioids from the VA or Part D only, dual users had a greater likelihood of potentially unsafe opioid use outcomes, including greater number of days on opioids, higher daily doses, and higher odds of chronic use. Conclusions Chronic GI patients in the VA may be frequent users of opioids and may have a unique set of risk factors for unsafe opioid use. Careful monitoring of opioid use among chronic GI patients may help to begin risk stratifying this group. and develop tailored approaches to minimize chronic use. The findings underscore potential nuances within the opioid epidemic and suggest that components of the VA’s Opioid Safety Initiative may need to be adapted around veterans at a higher risk of opioid-related adverse events.

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Opioid Prescribing Patterns of Optometrists in the Medicare Part D Database

Optometry and Vision Science ◽

10.1097/opx.0000000000001827 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Stephen C. Dryden ◽

Holly A. O’Malley ◽

Lindsey R. Adams ◽

Garrett C. Nix ◽

Jonathan E. Rho ◽

...

Keyword(s):

Medicare Part D ◽

Prescribing Patterns ◽

Medicare Part ◽

Part D ◽

Opioid Prescribing

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Using Matched Survey and Administrative Data to Estimate Eligibility for the Medicare Part D Low Income Subsidy Program

10.7249/wr743 ◽

2010 ◽

Cited By ~ 3

Author(s):

Erik Meijer ◽

Lynn Karoly ◽

Pierre-Carl Michaud

Keyword(s):

Administrative Data ◽

Low Income ◽

Medicare Part D ◽

Medicare Part ◽

Part D ◽

Subsidy Program

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Opioid Prescribing Practices of Neurosurgeons: Analysis of Medicare Part D

World Neurosurgery ◽

10.1016/j.wneu.2017.12.011 ◽

2018 ◽

Vol 112 ◽

pp. e31-e38 ◽

Cited By ~ 4

Author(s):

Syed I. Khalid ◽

Owoicho Adogwa ◽

Daniel T. Lilly ◽

Shyam A. Desai ◽

Victoria D. Vuong ◽

...

Keyword(s):

Medicare Part D ◽

Medicare Part ◽

Prescribing Practices ◽

Part D ◽

Opioid Prescribing

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Opioid Prescribing by Nurse Practitioners in Medicare Part D: Impact of State Scope of Practice Legislation

Medical Care Research and Review ◽

10.1177/1077558717725604 ◽

2017 ◽

Vol 76 (3) ◽

pp. 337-353 ◽

Cited By ~ 8

Author(s):

Elissa Ladd ◽

Casey Fryer Sweeney ◽

Anthony Guarino ◽

Alex Hoyt

Keyword(s):

Patient Safety ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

State Legislatures ◽

Medicare Part D ◽

Prescribing Patterns ◽

Medicare Part ◽

Scope Of Practice ◽

Part D ◽

Opioid Prescribing

Many state legislatures restrict nurse practitioner (NP) scope of practice as a way of addressing patient safety concerns. The purpose of this study was to investigate the influence of state NP scope of practice laws on the prescription of oxycodone and hydrocodone containing medications by NP and MD/DO/PA prescribers to Medicare Part D beneficiaries. Using the Medicare Part D public use file, we analyzed oxycodone and hydrocodone containing prescriptions per Medicare Part D beneficiary by prescriber type, NP state scope of practice, and geographic variables. Our results demonstrate that the state scope of practice variable had the same effect, in identical direction and significance, on NP opioid prescribing patterns as it had on MD/DO/PA prescribers, a group to whom NP scope of practice laws do not apply. Thus, scope of practice in this study was not an exclusive predictor of NP practice and prescribing.

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