Geographic analysis of military health system (MHS) buprenorphine prescribers and patients

2021 ◽  
Vol 17 (7) ◽  
pp. 87-100
Author(s):  
Fuad Issa, MD, FAPA ◽  
Christine Nguyen, MHA, PMP ◽  
Orolo Davies Abili, PharmD ◽  
Ruth F. Quah, MPH ◽  
Michael I. Engler, MPH ◽  
...  
Keyword(s):  
Health System ◽  
Secondary Data ◽  
The United States ◽  
Opioid Use Disorder ◽  
Direct Care ◽  
Opioid Use ◽  
Military Health System ◽  
Military Health ◽  
Geographical Maps ◽  
Care System

Objective: To demonstrate the prevalence of opioid use disorder (OUD) in the military health system (MHS), geographically map OUD patients and providers, and offer policy recommendations to help increase buprenorphine waiver prescribing.Design: This study was a retrospective review of data from the MHS records. Deidentified records of MHS OUD patients receiving buprenorphine were utilized. Secondary data with nonpersonally identifiable information (PII) were used for pulling records of buprenorphine prescribing providers within the direct care system (MHS providers) and providers from the purchased care system (civilian facilities accepting TRICARE beneficiaries).Setting: This study reviewed records of individuals within the MHS, in the United States, and its territories.Patients and participants: Patients within the MHS system with a diagnosis of OUD. Providers, within the MHS or purchased care, who had prescribed buprenorphine were selected.Main outcome measured: The number of OUD patients in the MHS and providers caring for these OUD patients. In addition, geographical maps illustrating the dispersion of OUD patients, and prescribers were created.Results: The vast majority of MHS OUD patients receive their care from purchase care. Between 2015 and 2018, there has been a shift in the number OUD diagnosed patients by region, and the number of OUD prescribers.Conclusion: The MHS population, particularly active duty, is a transient population. As such, it is not a surprise that the population of OUD patients or prescribers varied by region during that time period. Furthermore, results demonstrate that there is a need to increase the number of buprenorphine-waivered prescribers within the MHS. Changes in policy may encourage more providers to obtain the waiver or increase patient load. 

scholarly journals Examining Racial Disparities in Diabetes Readmissions in the United States Military Health System

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1679-e1685
Author(s):  
Dianne Frankel ◽  
Amanda Banaag ◽  
Cathaleen Madsen ◽  
Tracey Koehlmoos
Keyword(s):  
United States ◽  
Health System ◽  
The United States ◽  
Direct Care ◽  
Diabetic Patients ◽  
Military Health System ◽  
Military Health ◽  
Alaskan Native ◽  
Care System ◽  
White Patients

ABSTRACT Introduction Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities. Methods The study identified a population of 7,605 adult diabetic patients admitted to the hospital in 2014. Diagnostic codes were used to identify hospital readmissions, and logistic regression was used to analyze associations among race, beneficiary status, patient or sponsor’s rank, and readmissions at 30, 60, and 90 days. Results A total of 239 direct care patients and 545 purchased care patients were included in our analyses. After adjusting for age and sex, we found no significant difference in readmission rates for black versus white patients; however, we found a statistically significant increase in the likelihood for readmission of Native American/Alaskan Native patients compared to white patients, which persisted in direct care at 60 days (adjusted odds ratio [AOR] 11.51, 95% CI 1.11–119.41) and 90 days (AOR 18.42, 95% CI 1.78–190.73), and in purchased care at 90 days (AOR 4.54, 95% CI 1.31–15.74). Conclusion Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.

scholarly journals Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities

2020 ◽  
Vol 7 (6) ◽  
pp. 1234-1240
Author(s):  
Tara Trudnak Fowler ◽  
Kimberley Marshall Aiyelawo ◽  
Chantell Frazier ◽  
Craig Holden ◽  
Joseph Dorris
Keyword(s):  
Health Care ◽  
Prenatal Care ◽  
Health System ◽  
Care Program ◽  
The United States ◽  
Successful Implementation ◽  
Military Health System ◽  
Military Health ◽  
Individual Care ◽  
Enhanced Prenatal Care

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care ( p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care ( p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.

Postpartum Opioid Use Among Military Health System Beneficiaries: Lessons for the Nation [19R]

2019 ◽  
Vol 133 (1) ◽  
pp. 196S-196S
Author(s):  
Julie Watters ◽  
Amanda Banaag ◽  
Jason C. Massengill ◽  
Scott M. Petersen ◽  
Tracey Koehlmoos ◽  
...  
Keyword(s):  
Health System ◽  
Opioid Use ◽  
Military Health System ◽  
Military Health

scholarly journals Use of Integrative Medicine in the United States Military Health System

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Cathaleen Madsen ◽  
Megan Vaughan ◽  
Tracey Pérez Koehlmoos
Keyword(s):  
Health System ◽  
Integrative Medicine ◽  
Behavioral Therapy ◽  
The United States ◽  
Military Health System ◽  
Military Health ◽  
The Us ◽  
Usage Analysis ◽  
Full Relief ◽  
The Military

Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a “whole person” approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature “polytrauma triad” of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief. This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.

Postpartum Opioid Use among Military Health System Beneficiaries

2021 ◽  
Author(s):  
Julie A. Watters ◽  
Amanda Banaag ◽  
Jason C. Massengill ◽  
Tracey P. Koehlmoos ◽  
Barton C. Staat
Keyword(s):  
Health Care ◽  
Health System ◽  
Mode Of Delivery ◽  
Care Facility ◽  
Data Repository ◽  
Opioid Use ◽  
Military Health System ◽  
Opioid Prescription ◽  
Military Health ◽  
Military Health Care

Objective The aim of the study is to evaluate the prevalence and factors associated with opioid prescriptions to postpartum patients among TRICARE beneficiaries receiving care in the civilian health care system versus a military health care facility. Study Design We evaluated postpartum opioid prescriptions filled at discharge among patients insured by TRICARE Prime/Prime Plus using the Military Health System Data Repository between fiscal years 2010 to 2015. We included women aged 15 to 49 years old and excluded abortive pregnancy outcomes and incomplete datasets. The primary outcome investigated mode of delivery and demographics for those filling an opioid prescription. Secondary outcomes compared prevalence of filled opioid prescription at discharge for postpartum patients within civilian care and military care. Results Of a total of 508,258 postpartum beneficiaries, those in civilian health care were more likely to fill a discharge opioid prescription compared with those in military health care (OR 3.9, 95% CI 3.8–3.99). Cesarean deliveries occurred less frequently in military care (26%) compared with civilian care (30%), and forceps deliveries occurred more frequently in military care (1.38%) compared with civilian care (0.75%). Women identified as Asian race were least likely to fill an opioid prescription postpartum (OR 0.79, 95% CI 0.75–0.83). Women aged 15 to 19 years had a lower odds of filling an opioid prescription (OR 0.83, 95% CI 0.80–0.86). Women associated with a senior officer rank were less likely to fill an opioid prescription postpartum (OR 0.83, 95% CI 0.73–0.91), while those associated with warrant officer rank were more likely to fill an opioid prescription (OR 1.14, 95% CI 1.06–1.23). Conclusion Our data indicates that women who received care in civilian facilities were more likely to fill an opioid prescription at discharge when compared with military facilities. Factors such as race and age were associated with opioid prescription at discharge. This study highlights areas for improvement for potential further studies. Key Points

Trends in Surgical Volume in the Military Health System—A Potential Threat to Mission Readiness

2020 ◽  
Author(s):  
Austin Haag ◽  
Eugene B Cone ◽  
Jolene Wun ◽  
Peter Herzog ◽  
Samuel Lyon ◽  
...  
Keyword(s):  
Health System ◽  
Artery Bypass ◽  
Medical Personnel ◽  
Direct Care ◽  
Medical Procedure ◽  
Surgical Volume ◽  
Military Health System ◽  
Potential Threat ◽  
Military Health ◽  
The Military

ABSTRACT Introduction The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and to ensure that its active duty medical personnel maintain readiness for deployment. Knowledge, skills, and attitudes (KSA) is a metric evaluating the transferrable skills incorporated into a given surgery or medical procedure that are most relevant for surgeons deployed to a theatre of war. Procedures carrying a high KSA value are those utilizing skills with high relevance for maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs and the potential adverse impact on military surgeon mission readiness were high-value surgeries to be lost to the civilian sector, we evaluated trends in the setting of high-value surgeries for beneficiaries within the MHS. Methods We retrospectively analyzed inpatient admissions data from MTFs and TRICARE claims data from civilian hospitals, 2005-2019, to identify TRICARE-covered patients covered under “purchased care” (referred to civilian facilities) or receiving “direct care” (undergoing treatment at MTFs) and undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, and coronary artery bypass grafting (CABG). Overall and procedure-specific counts were captured, MTFs were categorized into quartiles by volume, and independence between trends was tested with a Cochran–Armitage test, hypothesizing that the proportion of cases referred for purchased care was increasing. Results We captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, and 45,028 carotid endarterectomies. The majority of cases included were referred for purchased care (90.3%), with the proportion of cases referred increasing over the study period (P &lt; .01). By procedure, all cases except AAA repairs were increasingly referred for treatment over the study period (all P &lt; .01, except esophagectomy P = .04). On examining volume, we found that even the highest-volume-quartile MTFs performed a median of less than one esophagectomy, hepatectomy, or pancreatectomy per month. The only included procedure performed once a month or more at the majority of MTFs was CABG. Conclusion On examining volume and referral trends for high-value surgeries within the MHS, we found low surgical volumes at the vast majority of included MTFs and an increasing proportion of cases referred to civilian hospitals over the last 15 years. Our findings illustrate missed opportunities for maintaining the mission readiness of military surgical personnel. Prioritizing the recapture of lost surgical volume may improve the surgical teams’ mission readiness.

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