Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans

Dados Bibliográficos

ID9103543
AutoresWesley C Becker (0000-0002-0788-1467, Yale University, autor correspondente), William C Becker (VA Connecticut Healthcare System West Haven), Brenda T Fenton (0000-0002-5882-9343, VA Connecticut Healthcare System West Haven, autor correspondente), Cynthia A Brandt (VA Connecticut Healthcare System West Haven), Cynthia Brandt (0000-0001-8179-1796, Yale University, autor correspondente), 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 correspondente), Brent A Moore (0000-0003-0123-6616, VA Connecticut Healthcare System West Haven, autor correspondente), 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 correspondente), Peter W Kreiner (Brandeis University Waltham, MA), Peter Kreiner (Brandeis University)
Ano2017
Volume55
FascículoSuppl 1
PáginasS33-S36
Data de publicação2017-07-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000722
PMID28410338
OpenAlexW2607140742
IdiomaEN
Citações recebidas3
Referências 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