RESUMEN
OBJECTIVE: To evaluate healthcare utilization in Medicaid enrolled children with neonatal abstinence syndrome (NAS) in the first 2 years of life. STUDY DESIGN: A retrospective, longitudinal cohort study evaluating Medicaid enrolled children born in New York (1999-2011) and Texas (1999-2010) was performed. Healthcare utilization, including inpatient days, emergency department and outpatient visits, and filled prescriptions in children after birth hospitalization was assessed. A tapered propensity-matching methodology was used, matching each child with NAS with 5 children without NAS, first on demographics, then on both demographics and clinical covariates (clinical diagnoses and congenital anomalies at birth). Poisson and negative binomial regression were used to calculate healthcare utilization ratios (HUR). RESULTS: In the first 2 years of life, children with NAS (n = 3799) had increased healthcare utilization with more inpatient days and emergency department visits than demographically similar children without NAS. This increased utilization however did not persist after matching on clinical covariates and performing multiple comparisons adjustment (inpatient days [HUR, 1.01; 95% CI, 0.88-1.16; P = .89], total emergency department visits [HUR, 1.06; 95% CI, 1.01-1.11; P = .02]). Children with NAS conversely had 9% fewer outpatient office visits (HUR, 0.91; 95% CI, 0.87-0.95; P < .0001). CONCLUSIONS: A diagnosis of NAS does not appear to be an independent predictor of increased healthcare utilization in the first 2 years of life. These results differ from some other published studies, but may suggest that the increased healthcare utilization observed in children with NAS is due to higher incidences of perinatal complications and congenital anomalies in children with prenatal drug exposures.
Asunto(s)
Síndrome de Abstinencia Neonatal/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Medicaid , New York , Estudios Retrospectivos , Texas , Factores de Tiempo , Estados UnidosRESUMEN
PURPOSE: Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. SUMMARY: The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. CONCLUSION: Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.
Asunto(s)
Analgésicos Opioides/efectos adversos , Dolor Crónico/tratamiento farmacológico , Prestación Integrada de Atención de Salud/organización & administración , Manejo del Dolor/métodos , Servicios Farmacéuticos/organización & administración , Implementación de Plan de Salud , Humanos , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/prevención & control , Manejo del Dolor/efectos adversos , Farmacéuticos/organización & administración , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To describe healthcare use over time of children with a history of neonatal abstinence syndrome (NAS) compared with children without NAS. STUDY DESIGN: In this retrospective, longitudinal cohort study, data were obtained from MarketScan Commercial Claims and Encounters database from 2005 to 2014. Children with and without NAS based on International Classification of Diseases, Ninth Revision diagnostic codes were followed until 8 years or disenrollment (mean: 35 months). Numbers of claims for inpatient, outpatient, and emergency department encounters; prescription drugs; and costs associated with these encounters were evaluated. RESULTS: Children with NAS had a significantly greater number of claims per year from age 1 to 8 for inpatient hospitalizations (adjusted mean ratio 3.20; 95% CI 1.74-5.90), outpatient encounters (1.23; 1.08-1.41), and emergency department visits (1.46; 1.25-1.70) after we adjusted for confounders. Subsequently, adjusted mean annualized costs were nearly double for all healthcare services in children with NAS (1.86; 1.34-2.60) and >4 times as high as for inpatient hospitalizations (4.34; 2.03-9.30) compared with children without NAS. CONCLUSIONS: Children with a diagnosis of NAS have significantly greater rates of healthcare use through age 8 years compared with children without NAS. These findings suggest that children affected by NAS have medical disparities that linger well beyond early infancy.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Síndrome de Abstinencia Neonatal/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Síndrome de Abstinencia Neonatal/epidemiología , Estudios Retrospectivos , Estados UnidosRESUMEN
Interprofessional education and international service learning (ISL) experiences are increasing in healthcare education and have the potential to broaden healthcare providers' strategies to manage patients' pain. After the addition of a physical therapy (PT) cohort to an existing interprofessional ISL, survey data was collected for program evaluation. Responses indicated altered ideation regarding the role of PT in pain management, and this theme was investigated further. Following two one-week interprofessional ISL experiences in Honduras in 2015 (Y1) and 2016 (Y2), participating students and preceptors in pharmacy, physician assistant and osteopathic medicine and Y1 PT preceptors were surveyed regarding their impressions of the PT cohort and the PT profession in general. Researchers performed thematic analysis to identify trends in responses, yielding three themes regarding PT's role in pain management: Patient Empowerment (46.2%), Management of Musculoskeletal Pain (42.3%), and Alternatives to Pharmacological Pain Management (11.5%). Results suggest that participating in an interprofessional ISL experience with a PT cohort encourages consideration of non-pharmacological methods to treat pain, including referral to PT to address musculoskeletal pain, and empowering patients to prevent or self-manage pain. These findings may be especially significant for under-resourced communities.
Asunto(s)
Relaciones Interprofesionales , Manejo del Dolor/normas , Grupo de Atención al Paciente/organización & administración , Especialidad de Fisioterapia/educación , Conducta Cooperativa , Honduras , Humanos , Proyectos Piloto , Investigación CualitativaRESUMEN
Tapentadol, a Schedule II opioid with a combination of µ-opioid activity and norepinephrine reuptake inhibition, is used for the management of moderate to severe acute and chronic pain. Its dual mechanism of action is thought to reduce opioid-related side effects that can complicate pain management. Since approval, tapentadol has been tracked across multiple outcomes suggesting abuse liability, and a pattern of relatively low, although not absent, abuse liability has been found. This retrospective cohort study further details the abuse liability of tapentadol as an active pharmaceutical ingredient (API) when immediate-release as well as extended-release formulations were on the market together (fourth quarter of 2011 to second quarter of 2016). Tapentadol (API) was compared with tramadol, hydrocodone, morphine, oxycodone, hydromorphone, and oxymorphone across Poison Center, Drug Diversion, and Treatment Center Programs Combined data streams from the Researched Abuse, Diversion and Addiction-Related Surveillance system. Findings suggest the public health burden related to tapentadol to date is low, but present. Event rates of abuse per population-level denominators were significantly lower than all other opioids examined. However, when adjusted for drug availability, event rates of abuse were lower than most Schedule II opioids studied, but were not the lowest. Disentangling these 2 sets of findings further by examining various opioid formulations, such as extended-release and the role of abuse-deterrent formulations, is warranted. PERSPECTIVE: This article presents the results from an examination of tapentadol API across the Researched Abuse, Diversion and Addiction-Related Surveillance System: a broad and carefully designed postmarketing mosaic. Data to date from Poison Center, Drug Diversion, and Treatment Centers combined suggest a low, but present public health burden related to tapentadol.