Filtering by: Medicaid
Jan
12
12:00 PM12:00
Opioids, Implementation Methods, Implementation Strategies, Medicaid

PSMG: Kimberly Johnson

Treatment for opioid use disorder in the Florida Medicaid population: A cascade of care approach to assessing quality.

Kimberly Johnson, Ph.D.
University of South Florida

ABSTRACT:
Despite increased funding, opioid overdose rates remain high. Understanding at what stage of the process and for whom the system is failing is critical to improving care. A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Using a CoC framework, we assessed treatment quality and outcomes for opioid use disorder for the Florida Medicaid population in 2017/2018 by demographics.

Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began medication, were retained on medication for a minimum of 180 days, and who died.

Results: Only 28% of those newly diagnosed with OUD in 2017 began treatment with an FDA approved medication. Once on medication, 38% of newly diagnosed enrollees were retained in treatment for at least 180 days. Those who remained in treatment for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate treatment, a reduction in mortality from 10% without care to 2% with care.

Conclusions: Initiating medication after diagnosis is the process most in need of improvement, though there is much room for improvement in treatment retention as well. The CoC is an appropriate method of measuring the quality of the functioning of the treatment system at the state level.

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Oct
8
12:00 PM12:00
Opioids, Medicaid

PSMG: Opioids - Arthur Robin Williams

Long-term buprenorphine treatment for OUD and adverse events following discontinuation among Medicaid beneficiaries

Arthur Robin Williams, M.D.
Department of Psychiatry, Columbia University

ABSTRACT:
Background: Buprenorphine reduces the risk of overdose and death among patients with opioid use disorder, yet to date, an empiric basis for the optimal length of treatment is lacking. Adverse health outcomes following buprenorphine discontinuation were compared among patients who were successfully retained beyond six months of continuous treatment akin to the "Retention" stage of the OUD Cascade of Care.

Methods: Retrospective longitudinal cohort within MarketScan multi-state US Medicaid claims (2013-2017) covering 12 million beneficiaries annually. The sample included adults 18-64 years old who received buprenorphine continuously for ≥180 days by cohorts retained for 6-9 months (n=4,126), 9-12 months (n=2,440), 12-15 months (n=1,499), and 15-18 months (n=931) with claims extending 6 months following discontinuation to assess outcome events. Primary adverse outcomes included all-cause emergency department visits, inpatient hospital admissions, filled opioid prescriptions, and overdose, controlling for demographic characteristics and comorbid mental health and substance use diagnoses.

Results: Rates of adverse events were high across all cohorts following buprenorphine discontinuation with approximately half of patients (42-50%) seen in the emergency department at least once during the 6 months following discontinuation. Compared to those retained for 6-9 months, patients retained for 15-18 months had lower odds of all-cause emergency department visits (OR 0.70, 95%CI 0.60-0.90, p<0.001), all-cause inpatient hospitalizations (OR 0.80, 95% CI 0.6-1.0, p<0.05), and filling opioid prescriptions (OR 0.70, 95%CI 0.60-0.80, p<0.001) in the six months following discontinuation. Approximately 5% of persons across all cohorts experienced one or more medically treated overdoses in the 6 months following buprenorphine discontinuation. Analysis was limited to beneficiaries in multiple unidentified states and could not account for mortality outcomes.

Conclusion: Risk of acute care service use and overdose were high following buprenorphine discontinuation irrespective of treatment duration. Superior outcomes became significant with treatment duration beyond 15 months but remained concerning suggesting a minimum of 6 months is insufficient. Improvements at all levels of care are needed to increase retention of patients on buprenorphine.

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