scholarly journals Builiding Methods for a Proactive Prescription Drug Surveillance System

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Xiong
Keyword(s):  
Prescription Drug ◽  
Surveillance System ◽  
Recurrent Event ◽  
Epidemiological Methods ◽  
High Dose ◽  
Prescription Opioids ◽  
Event Analysis ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Dependent Observations

ObjectiveThis study aims to show the application of longitudinal statisticaland epidemiological methods for building a proactive prescriptiondrug surveillance system for public health.IntroductionPrescription Drug Monitoring Programs (PDMPs) are operating in49 states and several U.S. territories. Current methods for surveillanceof prescription drug related behaviors, include the mean daily dosageof morphine milligram equivalent (MME) per patient, annualpercentage of days with overlapping prescriptions per patient, andannual multiple provider episodes for multiple controlled substanceprescription drugs per patient that are described elsewhere.1,2Thiswork builds on these efforts by extending longitudinal methodsto prescription drug behavior surveillance in order to predict risksassociated with prescription drug use.MethodsSchedule II prescription opioids from January 1, 2014 to February29, 2016 from the Kansas Tracking and Reporting of ControlledSubstances (KTRACS) was used for this analysis. Prescription opioidswere linked to the 2016 version of the morphine milligram equivalentconversion table from the National Center for Injury Preventionand Control.3Population estimates were based on the 2015 CountyVintage single-year of age bridged-race estimates from the NationalCenter for Health Statistics and used to calculate age-adjusted rates. Adaily high dose opioid prescription was defined as having greater thanor equal to 90 morphine milligram equivalent. Since this is a unit-daymeasure with patients experiencing multiple daily high dose opioiddays, the Prentice, William, and Peterson (PWP) recurrent eventmodel was used to estimate the number of high-dose opioid days forKansas patients by gender and age groups.4,5Start time was the firstprescription date with a high-dose opioid and stop time was the nexthigh-dose opioid date during a study period from January 1, 2014to Feb 29, 2016. The PWP model is a statistical model that allowsfor the estimation of covariates on an event history (i.e. total timewith prescription opioids, specifically high-dose opioids). Analysiswas completed with a stratified Cox-proportional hazard model,sandwich covariance for dependent observations, and statisticalsignificance was assessed with a Wald Chi-square. PROC PHREGin SAS/STAT(R) 14.1 was used since it has a new FAST option forfitting large proportional counting process hazard model.ResultsThe age-adjusted rate of daily high-dose opioid patients was3.2 patients per 100 Kansas population-year (95% CI: 3.1 – 3.2).Kansas patients aged 85 and older had the highest age-specific rateof 11.7 (95% CI: 11.5 –11.9). Preliminary recurrent event analysisshows on average nearly a quarter of approximately 50 millionSchedule II opioid patient days were high-dose opioid patient daysamong 785,514 Kansan patients with any prescribed opioid history.In an initial result stratified by the number of high-dose opioid daysand adjusting only for age, males on average had approximately 7%higher hazard of recurrent Schedule II high-dose opioid prescriptiondays than females (β: 0.07, S.E: 0.002, p<0.0001). Kansas patientsaged 45 to 54 compared to Kansas patients 85 and older on averagehad approximately 14% higher hazard of recurrent Schedule II high-dose opioid prescription days (β: 0.14, S.E: 0.007, p<0.0001).ConclusionsThis work demonstrates the application of survival analysistechniques to estimate the population at risk for high-dose opioids,which varies by the length of the total opioid prescription history. Earlyresults from the recurrent event analysis showed that Kansas maleand patients aged 45 to 54 years had the longest history of high-doseopioids. Annual cross-sectional population estimates may incorrectlyestimate the estimated risk of high-dose prescription opioids sinceit assumes all patients have the same prescription history. PDMPsare longitudinal databases. Survival analysis methods like recurrentevent models can leverage the longitudinal structure to more preciselyestimate risk statistics. Future work includes incorporation of healthoutcomes data and further prescription covariates to assess the timingand intensity of opioid potency escalation.

scholarly journals Prescription Opioid Abuse: Gleaning insights from hospital and vital records data

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Reka Sundaram-Stukel ◽  
Ousmane Diallo ◽  
Benjamin Wiseman ◽  
Richard E. Miller
Keyword(s):  
Mental Health ◽  
Prescription Drug ◽  
Prescription Drugs ◽  
The United States ◽  
Hospital Charges ◽  
Prescription Opioids ◽  
Opioid Prescription ◽  
Discharge Data ◽  
Operative Recovery ◽  
The Impact

ObjectiveIn this paper we used hospital charges to assess costs incurred dueto prescription drug/opioid hospitalizationsIntroductionThere is a resurgence in the need to evaluate the economic burdenof prescription drug hospitalizations in the United States. We used theWisconsin 2014 Hospital Discharge data to examine opioid relatedhospitalization incidence and costs. Fentanyl, a powerful syntheticopioid, is frequently being used for as an intraoperative agent inanesthesia, and post-operative recovery in hospitals. According to a2013 study, synthetic Fentanyl is 40 times more potent than heroinand other prescription opioids; the strength of Fentanyl leads tosubstantial hospitalizations risks. Since, 1990 it has been availablewith a prescription in various forms such as transdermal patches orlollipops for treatment of serious chronic pain, most often prescribedfor late stage cancer patients. There have been reported fatal overdosesassociated with misuse of prescription fentanyl. In Wisconsin numberof total opioid related deaths increased by 51% from 2010 to 2014with the number of deaths involving prescription opioids specificallyincreased by 23% and number of deaths involving heroin increasedby 192%. We hypothesized that opioids prescription drugs, as a proxyof Fentanyl use, result in excessive health care costs.MethodsOpioid hospitalizations was defined as any mention of the ICD9codes (304,305) in any diagnostic field or the mention of (:E935.09) onthe first listed E-code. Our analysis used the Heckman 2-stage model,a method often used by Economists in absence of randomized controltrials. In presence of unobserved choice, for example opioid relatedhospitalizations, there usually is a correlation between error in anunderlying function (fentanyl prescription) and an estimated function(hospital charges) that introduces a selection bias. Heckman treats thiscorrelation between errors as an omitted variable bias. Therefore, weestimate a Heckman two step model using hospitalization: where theselection function is the probability of being hospitalized for syntheticopioid via logistic regression. Finally, we estimate the hospitalcharges realized if the patient was given opioids.ResultsMale patients are significantly more likely to be hospitalized foropioids than are female patients; while white patients are significantlymore likely to be admitted for opioid usage than other racialgroups. We also find that comorbid factors, such as mental health,significantly impact hospital charges associated with opioid use. Wefind that persons with private health insurance are associated withhigher rates of opioid use.ConclusionsUsing a Heckman two step approach we show that comorbidconditions such as mental health, Hepatitis C, injuries, etc significantlyaffect hospital charges associated with hospitalization. We usethese findings to explore the impact of the 2013 rule mandatingdoctors share opioid prescription information on the incidence ofopioid related death and hospital charges associated with opioidprescriptions. This work is policy relevant because alternatives toopioid prescription such as meditation, pain management therapiesmay be relevant.

scholarly journals The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015

2019 ◽  
Vol 134 (6) ◽  
pp. 667-674 ◽  
Author(s):  
Alexander Y. Walley ◽  
Dana Bernson ◽  
Marc R. Larochelle ◽  
Traci C. Green ◽  
Leonard Young ◽  
...  
Keyword(s):  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Opioid Use Disorder ◽  
Medical Examiner ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Drug Monitoring Program ◽  
Opioid Medications

Objectives: Opioid-related overdoses are commonly attributed to prescription opioids. We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens. Methods: Among opioid-related overdose decedents in Massachusetts during 2013-2015, we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report. We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents’ toxicology reports. Results: Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death. Conclusion: Linking overdose toxicology reports to prescription drug monitoring program records can help attribute overdoses to prescribed opioids, diverted prescription opioids, heroin, and illicitly made fentanyl.

Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: cross-sectional and time-to-recurrent-event analyses

2020 ◽  
pp. 1-10
Author(s):  
Nicolas J. C. Stapelberg ◽  
Jerneja Sveticic ◽  
Ian Hughes ◽  
Alice Almeida-Crasto ◽  
Taralina Gaee-Atefi ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Suicide Attempts ◽  
Public Mental Health ◽  
Evidence Base ◽  
Recurrent Event ◽  
Event Analysis ◽  
Indigenous Status ◽  
Cross Sectional ◽  
Repeated Suicide Attempt ◽  
Sectional Analysis

Background The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness. Aims To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt. Method A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009–2018) for the cohort was used in time-to-recurrent-event analyses. Results Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11–0.75), 14 days (RR = 0.38; 95% CI 0.18–0.78), 30 days (RR = 0.55; 95% CI 0.33–0.94) and 90 days (RR = 0.62; 95% CI 0.41–0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57–0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03–3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46–2.17) and Indigenous status (HR = 1.46; 95% CI 0.98–2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86–0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP. Conclusions This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals Data of the COVID-19 mRNA-Vaccine V-Safe Surveillance System and Pregnancy Registry Reveals Poor Embryonic and Second Trimester Fetal Survival Rate. Comment on Stuckelberger et al. SARS-CoV-2 Vaccine Willingness among Pregnant and Breastfeeding Women during the First Pandemic Wave: A Cross-Sectional Study in Switzerland. Viruses 2021, 13, 1199

Viruses ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1545 ◽  
Author(s):  
Serge Stroobandt ◽  
Roland Stroobandt
Keyword(s):  
Survival Rate ◽  
Surveillance System ◽  
Cross Sectional Study ◽  
Second Trimester ◽  
Sectional Study ◽  
Cross Sectional ◽  
Fetal Survival ◽  
Pregnancy Registry ◽  
Pandemic Wave

Dr. Sarah Stuckelberger and her colleagues should be commended for their cross-sectional study assessing the willingness of Swiss pregnant and breastfeeding women to be vaccinated against SARS-CoV-2 [...]

scholarly journals Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 60
Author(s):  
Jyoti Acharya ◽  
Maria Zolfo ◽  
Wendemagegn Enbiale ◽  
Khine Wut Yee Kyaw ◽  
Meika Bhattachan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Surveillance System ◽  
Surveillance Data ◽  
World Health ◽  
Cross Sectional ◽  
Antimicrobial Resistance Surveillance ◽  
Data Collection Process ◽  
Data Compilation ◽  
Site Variation ◽  
Health Organization

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.

scholarly journals Breathlessness and opioid prescribing in COPD in general practice: a cross-sectional, observational study

2020 ◽  
Vol 6 (2) ◽  
pp. 00299-2019
Author(s):  
David C. Currow ◽  
Miriam J. Johnson ◽  
Allan Pollack ◽  
Diana H. Ferreira ◽  
Slavica Kochovska ◽  
...  
Keyword(s):  
General Practice ◽  
Clinical Care ◽  
Cross Sectional Study ◽  
Prescribing Patterns ◽  
Pain Patient ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Obstructive Pulmonary Disease ◽  
Health Database

Chronic breathlessness is a disabling syndrome, prevalent in people with advanced chronic obstructive pulmonary disease (COPD). Regular, low-dose, oral sustained-release morphine is approved in Australia to reduce symptomatic chronic breathlessness. We aimed to determine the current prescribing patterns of opioids for chronic breathlessness in COPD in Australian general practice and to define any associated patient and practitioner characteristics.Five years (2011 to 2016) of the Bettering the Evaluation and Care of Health database, an Australian national, continual, cross-sectional study of clinical care in general practice were used. The database included 100 consecutive clinical encounters from almost 1000 general practitioners annually (n=488 100 encounters). Descriptive analyses with subsequent regression models were generated.Breathlessness as a patient-defined reason for encounter was identified in 621 of 4522 encounters where COPD was managed. Opioids were prescribed in 309 of 4522 encounters where COPD was managed (6.8%; (95% CI) 6.1–7.6), of which only 17 were prescribed for breathlessness, and the rest for other conditions almost entirely related to pain. Patient age (45–64 years versus age 80+ years, OR 1.68; 1.19–2.36), Commonwealth Concession Card holders (OR 1.70; 1.23–2.34) and socioeconomic disadvantage (OR 1.30; 1.01–1.68) were associated with increased likelihood of opioid prescription at COPD encounters. The rate of opioid prescriptions rose over the 5 years of study.In primary care encounters for COPD, opioids were prescribed in 6.8% of cases, but almost never for breathlessness. These data create a baseline against which to compare changes in prescribing as the treatment of chronic breathlessness evolves.

scholarly journals Impact of prescription drug monitoring program mandate on postoperative opioid prescriptions in children

2021 ◽  
Author(s):  
Christina M. Theodorou ◽  
Jordan E. Jackson ◽  
Ganesh Rajasekar ◽  
Miriam Nuño ◽  
Kaeli J. Yamashiro ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Prescription Drug ◽  
Drug Monitoring ◽  
Monitoring Program ◽  
Interrupted Time Series ◽  
Surgical Patients ◽  
Interrupted Time Series Analysis ◽  
Opioid Prescription ◽  
Series Analysis

Abstract Purpose Prescription drug monitoring programs (PDMPs) have been established to combat the opioid epidemic, but there is no data on their efficacy in children. We hypothesized that a statewide PDMP mandate would be associated with fewer opioid prescriptions in pediatric surgical patients. Methods Patients < 18 undergoing inguinal hernia repair, orchiopexy, orchiectomy, appendectomy, or cholecystectomy at a tertiary children’s hospital were included. The primary outcome, discharge opioid prescription, was compared for 10 months pre-PDMP (n = 158) to 10 months post-PDMP (n = 228). Interrupted time series analysis was performed to determine the effect of the PDMP on opioid prescribing. Results Over the 20-month study period, there was an overall decrease in the rate of opioid prescriptions per month (− 3.6% change, p < 0.001). On interrupted time series analysis, PDMP implementation was not associated with a significant decrease in the monthly rate of opioid prescriptions (1.27% change post-PDMP, p = 0.4). However, PDMP implementation was associated with a reduction in opioid prescriptions of greater than 5 days’ supply (− 2.7% per month, p = 0.03). Conclusion Opioid prescriptions declined in pediatric surgical patients over the study time period. State-wide PDMP implementation was associated with a reduction in postoperative opioid prescriptions of more than 5 days’ duration.

scholarly journals Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jason W. Busse ◽  
Joyce Douglas ◽  
Tara S. Chauhan ◽  
Bilal Kobeissi ◽  
Jeff Blackmer
Keyword(s):  
Online Survey ◽  
Preliminary Evidence ◽  
Opioid Therapy ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Opioid Tapering ◽  
Noncancer Pain

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

Sign in / Sign up

Export Citation Format

Share Document