Evaluation of a Medicaid performance improvement project to reduce high-dose opioid prescriptions.

Autor: Hartung DM; Oregon State University, College of Pharmacy, 2730 S Moody Ave., CL5CP, Portland, OR, 97201, USA. hartungd@ohsu.edu.; Oregon Health & Science University, 3181 SW Sam Jackson Park Rc, Portland, Oregon, 97239, USA. hartungd@ohsu.edu., Geddes J; Oregon Health & Science University, 3181 SW Sam Jackson Park Rc, Portland, Oregon, 97239, USA., Hallvik SE; Comagine Health, 650 NE Holladay St., Portland, OR, 97232, USA., Korthuis PT; Oregon Health & Science University, 3181 SW Sam Jackson Park Rc, Portland, Oregon, 97239, USA., Middleton L; Oregon State University, College of Pharmacy, 2730 S Moody Ave., CL5CP, Portland, OR, 97201, USA., Leichtling G; Comagine Health, 650 NE Holladay St., Portland, OR, 97232, USA., Hildebran C; Comagine Health, 650 NE Holladay St., Portland, OR, 97232, USA., Kim H; Oregon Health & Science University, 3181 SW Sam Jackson Park Rc, Portland, Oregon, 97239, USA.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2022 Jan 14; Vol. 22 (1), pp. 68. Date of Electronic Publication: 2022 Jan 14.
DOI: 10.1186/s12913-022-07477-6
Abstrakt: Background: In 2015, Oregon's Medicaid program implemented a performance improvement project to reduce high-dose opioid prescribing across its 16 coordinated care organizations (CCOs). The objective of this study was to evaluate the effect of that program on prescription opioid use and outcomes.
Methods: Using Medicaid claims data from 2014 to 2017, we conducted interrupted time-series analyses to examine changes in the prescription opioid use and overdose rates before (July 2014 to June 2015) and after (January 2016 to December 2017) implementation of Oregon's high-dose policy initiative (July 2015 to December 2015). Prescribing outcomes were: 1) total opioid prescriptions 2) high-dose [> 90 morphine milligram equivalents per day] opioid prescriptions, and 3) proportion of opioid prescriptions that were high-dose. Opioid overdose outcomes included emergency department visits or hospitalizations that involved an opioid-related poisoning (total, heroin-involved, non-heroin involved). Analyses were performed at the state and CCO level.
Results: There was an immediate reduction in high dose opioid prescriptions after the program was implemented (- 1.55 prescription per 1000 enrollee; 95% CI - 2.26 to - 0.84; p < 0.01). Program implementation was also associated with an immediate drop (- 1.29 percentage points; 95% CI - 1.94 to - 0.64 percentage points; p < 0.01) and trend reduction (- 0.23 percentage point per month; 95% CI - 0.33 to - 0.14 percentage points; p < 0.01) in the monthly proportion of high-dose opioid prescriptions. The trend in total, heroin-involved, and non-heroin overdose rates increased significantly following implementation of the program.
Conclusions: Although Oregon's high-dose opioid performance improvement project was associated with declines in high-dose opioid prescriptions, rates of opioid overdose did not decrease. Policy efforts to reduce opioid prescribing risks may not be sufficient to address the growing opioid crisis.
(© 2022. The Author(s).)
Databáze: MEDLINE
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