Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans

Datos Bibliográficos

ID9103543
AutoresWesley C Becker (0000-0002-0788-1467, Yale University, autor de correspondencia), William C Becker (VA Connecticut Healthcare System West Haven), Brenda T Fenton (0000-0002-5882-9343, VA Connecticut Healthcare System West Haven, autor de correspondencia), Cynthia A Brandt (VA Connecticut Healthcare System West Haven), Cynthia Brandt (0000-0001-8179-1796, Yale University, autor de correspondencia), Erin L Doyle (Brandeis University Waltham, MA), Erin Doyle (0000-0001-9880-7440, Brandeis University), Joseph Francis (0000-0002-8782-9828, Office of Clinical Analytics and Reporting, Veterans Health Administration, Washington, DC), Joseph L Goulet (0000-0002-0842-804X, VA Connecticut Healthcare System West Haven, autor de correspondencia), Brent A Moore (0000-0003-0123-6616, VA Connecticut Healthcare System West Haven, autor de correspondencia), Virginia Torrise (Office of Clinical Analytics and Reporting, Veterans Health Administration, Washington, DC), Robert D Kerns (0000-0001-7609-2771, VA Connecticut Healthcare System West Haven, autor de correspondencia), Peter W Kreiner (Brandeis University Waltham, MA), Peter Kreiner (Brandeis University)
Año2017
Volumen55
NúmeroSuppl 1
PáginasS33-S36
Fecha de publicación2017-07-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000722
PMID28410338
OpenAlexW2607140742
IdiomaEN
Citas recibidas3
Referencias citadas13

BACKGROUND: Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. OBJECTIVES: We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. RESEARCH DESIGN: Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015. MEASURES: Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. RESULTS: Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. CONCLUSIONS: Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy

Business · Family medicine · Health care · Logistic regression · Medicaid · Medical prescription · Medicare Part D · Odds · Opioid · Payment · Prescription drug · Emergency Medicine · Finance · HIV, Drug Use, Sexual Risk · Internal Medicine · Medicine · Nursing · Opioid Use Disorder Treatment · Substance Abuse Treatment and Outcomes