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Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees.
J Manag Care Spec Pharm. 2018 Sep; 24(9):875-885.JM

Abstract

BACKGROUND

The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines.

OBJECTIVE

To examine the prevalence of the PQA measures and identify the patient demographic and health characteristics associated with the measures.

METHODS

We conducted a cross-sectional analysis using Pennsylvania Medicaid data (2013-2015). We limited our analyses to noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess ≥ 2 opioid prescriptions for ≥ 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for ≥ 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from ≥ 4 providers and ≥ 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as ≥ 30 cumulative days of overlapping opioids and benzodiazepines among individuals having ≥ 2 opioid and ≥ 2 benzodiazepine fills. Patient characteristics assessed included demographics; other medication use; and physical, mental, and behavioral health comorbidities. We present descriptive and multivariable statistical analyses of the data to describe trends in quality measure prevalence and associations with enrollee health characteristics.

RESULTS

Numbers of enrollees meeting inclusion criteria ranged from 73,082 in 2013 to 85,710 in 2015. From 2013 to 2015, high dosage prevalence increased from 5.1% to 5.5%; the use of multiple providers/pharmacies decreased from 7.1% to 5.0%; and concurrent use of opioids and benzodiazepines decreased from 29.1% to 28.4% (all P < 0.05). A substantial portion of patients with > 1 PQA measure from 2013 to 2015 was eligible for Medicaid because of disability (41.8%-81.9%). Enrollees with opioid use disorder were more likely to have high dosages (adjusted odds ratio [AOR] = 2.01, 95% CI = 1.83-2.21). Enrollees with anxiety and mood disorders were more likely to have multiple providers/pharmacies (anxiety: AOR = 1.54, 95% CI = 1.43-1.65; mood: AOR = 1.15, 95% CI = 1.06-1.25) and concurrent use of opioids and benzodiazepines (anxiety: AOR = 3.50, 95% CI = 3.38-3.63; mood: AOR = 1.42, 95% CI = 1.36-1.48).

CONCLUSIONS

Given high levels of eligibility based on disability and the prevalence of mood, anxiety, and opioid use disorders among those identified by the quality measures, providers may require additional support to care for this patient population.

DISCLOSURES

This project was supported by a grant from the Centers for Disease Control and Prevention and was also supported by an intergovernmental agreement between the Pennsylvania Department of Human Services and the University of Pittsburgh. Lo-Ciganic was supported by the University of Arizona Health Sciences Career Development Award. The other authors have nothing to disclose. The conclusions, findings, and opinions expressed by authors contributing to this article do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the Commonwealth of Pennsylvania. A portion of these results was presented at the Association for Medical Education and Research in Substance Abuse 41st National Conference; November 2-4, 2017; Washington, DC.

Authors+Show Affiliations

1 University of Pittsburgh School of Social Work; University of Pittsburgh School of Medicine, Department of Psychiatry; and University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, Pittsburgh, Pennsylvania.6 University of Arizona College of Pharmacy, Tucson.2 VA Pittsburgh Healthcare System; University of Pittsburgh School of Medicine, Division of General Internal Medicine; and University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, Pittsburgh, Pennsylvania.7 University of Utah School of Medicine, Division of General Internal Medicine, and VA Salt Lake City Healthcare System, Salt Lake City, Utah.3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.4 University of Pittsburgh School of Medicine, Division of General Internal Medicine, Pittsburgh, Pennsylvania.3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.5 University of Pittsburgh Graduate School of Public Health, and University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, Pittsburgh, Pennsylvania.8 Medical Assistance Programs, Pennsylvania Department of Human Services, Harrisburg, Pennsylvania.5 University of Pittsburgh Graduate School of Public Health, and University of Pittsburgh Center for Pharmaceutical Policy and Prescribing, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30156454

Citation

Cochran, Gerald, et al. "Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees." Journal of Managed Care & Specialty Pharmacy, vol. 24, no. 9, 2018, pp. 875-885.
Cochran G, Lo-Ciganic WH, Gellad WF, et al. Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees. J Manag Care Spec Pharm. 2018;24(9):875-885.
Cochran, G., Lo-Ciganic, W. H., Gellad, W. F., Gordon, A. J., Cole, E., Lobo, C., Frazier, W., Zheng, P., Chang, C. H., Kelley, D., & Donohue, J. M. (2018). Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees. Journal of Managed Care & Specialty Pharmacy, 24(9), 875-885. https://doi.org/10.18553/jmcp.2018.24.9.875
Cochran G, et al. Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees. J Manag Care Spec Pharm. 2018;24(9):875-885. PubMed PMID: 30156454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescription Opioid Quality Measures Applied Among Pennsylvania Medicaid Enrollees. AU - Cochran,Gerald, AU - Lo-Ciganic,Wei-Hsuan, AU - Gellad,Walid F, AU - Gordon,Adam J, AU - Cole,Evan, AU - Lobo,Carroline, AU - Frazier,Winfred, AU - Zheng,Ping, AU - Chang,Chung-Chou H, AU - Kelley,David, AU - Donohue,Julie M, PY - 2018/8/30/entrez PY - 2018/8/30/pubmed PY - 2018/12/12/medline SP - 875 EP - 885 JF - Journal of managed care & specialty pharmacy JO - J Manag Care Spec Pharm VL - 24 IS - 9 N2 - BACKGROUND: The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines. OBJECTIVE: To examine the prevalence of the PQA measures and identify the patient demographic and health characteristics associated with the measures. METHODS: We conducted a cross-sectional analysis using Pennsylvania Medicaid data (2013-2015). We limited our analyses to noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess ≥ 2 opioid prescriptions for ≥ 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for ≥ 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from ≥ 4 providers and ≥ 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as ≥ 30 cumulative days of overlapping opioids and benzodiazepines among individuals having ≥ 2 opioid and ≥ 2 benzodiazepine fills. Patient characteristics assessed included demographics; other medication use; and physical, mental, and behavioral health comorbidities. We present descriptive and multivariable statistical analyses of the data to describe trends in quality measure prevalence and associations with enrollee health characteristics. RESULTS: Numbers of enrollees meeting inclusion criteria ranged from 73,082 in 2013 to 85,710 in 2015. From 2013 to 2015, high dosage prevalence increased from 5.1% to 5.5%; the use of multiple providers/pharmacies decreased from 7.1% to 5.0%; and concurrent use of opioids and benzodiazepines decreased from 29.1% to 28.4% (all P < 0.05). A substantial portion of patients with > 1 PQA measure from 2013 to 2015 was eligible for Medicaid because of disability (41.8%-81.9%). Enrollees with opioid use disorder were more likely to have high dosages (adjusted odds ratio [AOR] = 2.01, 95% CI = 1.83-2.21). Enrollees with anxiety and mood disorders were more likely to have multiple providers/pharmacies (anxiety: AOR = 1.54, 95% CI = 1.43-1.65; mood: AOR = 1.15, 95% CI = 1.06-1.25) and concurrent use of opioids and benzodiazepines (anxiety: AOR = 3.50, 95% CI = 3.38-3.63; mood: AOR = 1.42, 95% CI = 1.36-1.48). CONCLUSIONS: Given high levels of eligibility based on disability and the prevalence of mood, anxiety, and opioid use disorders among those identified by the quality measures, providers may require additional support to care for this patient population. DISCLOSURES: This project was supported by a grant from the Centers for Disease Control and Prevention and was also supported by an intergovernmental agreement between the Pennsylvania Department of Human Services and the University of Pittsburgh. Lo-Ciganic was supported by the University of Arizona Health Sciences Career Development Award. The other authors have nothing to disclose. The conclusions, findings, and opinions expressed by authors contributing to this article do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the Commonwealth of Pennsylvania. A portion of these results was presented at the Association for Medical Education and Research in Substance Abuse 41st National Conference; November 2-4, 2017; Washington, DC. SN - 2376-1032 UR - https://www.unboundmedicine.com/medline/citation/30156454/Prescription_Opioid_Quality_Measures_Applied_Among_Pennsylvania_Medicaid_Enrollees_ L2 - https://www.jmcp.org/doi/10.18553/jmcp.2018.24.9.875?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -