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Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users.
J Manag Care Spec Pharm. 2019 Mar; 25(3):392-401.JM

Abstract

BACKGROUND

The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse.

OBJECTIVE

To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations).

METHODS

The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis.

RESULTS

After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits.

CONCLUSIONS

The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular.

DISCLOSURES

Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.

Authors+Show Affiliations

1 HealthCore, Wilmington, Delaware.1 HealthCore, Wilmington, Delaware.1 HealthCore, Wilmington, Delaware.1 HealthCore, Wilmington, Delaware.2 Anthem, Indianapolis, Indiana.1 HealthCore, Wilmington, Delaware.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30816820

Citation

Chen, Xiaoxue, et al. "Effect of Controlled Substance Use Management On Prescribing Patterns and Health Outcomes Among High-Risk Users." Journal of Managed Care & Specialty Pharmacy, vol. 25, no. 3, 2019, pp. 392-401.
Chen X, Ma Q, Barron J, et al. Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users. J Manag Care Spec Pharm. 2019;25(3):392-401.
Chen, X., Ma, Q., Barron, J., DeVries, A., Horn, J., & Agiro, A. (2019). Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users. Journal of Managed Care & Specialty Pharmacy, 25(3), 392-401. https://doi.org/10.18553/jmcp.2019.25.3.392
Chen X, et al. Effect of Controlled Substance Use Management On Prescribing Patterns and Health Outcomes Among High-Risk Users. J Manag Care Spec Pharm. 2019;25(3):392-401. PubMed PMID: 30816820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users. AU - Chen,Xiaoxue, AU - Ma,Qinli, AU - Barron,John, AU - DeVries,Andrea, AU - Horn,Jennifer, AU - Agiro,Abiy, PY - 2019/3/1/entrez PY - 2019/3/1/pubmed PY - 2019/4/26/medline SP - 392 EP - 401 JF - Journal of managed care & specialty pharmacy JO - J Manag Care Spec Pharm VL - 25 IS - 3 N2 - BACKGROUND: The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. OBJECTIVE: To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). METHODS: The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. RESULTS: After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. CONCLUSIONS: The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. DISCLOSURES: Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem. SN - 2376-1032 UR - https://www.unboundmedicine.com/medline/citation/30816820/Effect_of_Controlled_Substance_Use_Management_on_Prescribing_Patterns_and_Health_Outcomes_Among_High_Risk_Users_ L2 - https://dx.doi.org/10.18553/jmcp.2019.25.3.392 DB - PRIME DP - Unbound Medicine ER -