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Physician networks and potentially inappropriate opioid prescriptions.
J Addict Dis. 2020 Jul-Sep; 38(3):301-310.JA

Abstract

Background: Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines.Objectives: Examine associations between care networks defined by shared patients and problematic opioid prescribing.Methods: Analysis was at the provider-year level. Social network analysis (SNA) applied to the Medicaid MarketScan® Research Database for the years 2010-2015 identified care communities, each community's level of integration (centralization), and each provider's integration (centrality). Nested multivariable logistic regressions controlling for patient mix and provider specialty simultaneously examined the risk of any (incident) and repeated (prevalent) inappropriate prescribing.Outcomes: Four behaviors defined by the CDC guidelines were examined: (1) more than 90 days continuous supply of high-dose opioid analgesics for chronic pain, (2) overlapping opioid supplies, (3) overlapping opioid and benzodiazepine prescriptions, and (4) prescribing an extended release opioid for an acute pain diagnosis.Results: Provider centrality was associated with reduced incidence of outcome (2) (OR: 0.95) and decreased prevalence of outcomes (1), (2), and (3). However, higher incidence (OR: 1.32) and prevalence (OR: 1.027) of outcome (4) were observed. Conversely, centralization associated with decreased incidence of (1) and (2) and lower prevalence of (1), (2), and (3).Conclusions: Greater provider integration is associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription is more ambiguous.

Authors+Show Affiliations

Agency for Healthcare Research and Quality, Rockville, MD, USA.Social & Scientific Systems, A DLH Company, Silver Spring, MD, USA.Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC, USA.Premier Inc., Charlotte, NC, USA.Division of Health, Retirement, and Long Term Analysis, Congressional Budget Office, Washington, DC, USA.IBM Watson Health, Cambridge, MA, USA.IBM Watson Health, Cambridge, MA, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32378481

Citation

McClellan, Chandler, et al. "Physician Networks and Potentially Inappropriate Opioid Prescriptions." Journal of Addictive Diseases, vol. 38, no. 3, 2020, pp. 301-310.
McClellan C, Flottemesch TJ, Ali MM, et al. Physician networks and potentially inappropriate opioid prescriptions. J Addict Dis. 2020;38(3):301-310.
McClellan, C., Flottemesch, T. J., Ali, M. M., Jones, J., Mutter, R., Hohlbauch, A., & Whalen, D. (2020). Physician networks and potentially inappropriate opioid prescriptions. Journal of Addictive Diseases, 38(3), 301-310. https://doi.org/10.1080/10550887.2020.1760655
McClellan C, et al. Physician Networks and Potentially Inappropriate Opioid Prescriptions. J Addict Dis. 2020 Jul-Sep;38(3):301-310. PubMed PMID: 32378481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician networks and potentially inappropriate opioid prescriptions. AU - McClellan,Chandler, AU - Flottemesch,Thomas J, AU - Ali,Mir M, AU - Jones,Jenna, AU - Mutter,Ryan, AU - Hohlbauch,Andriana, AU - Whalen,Daniel, Y1 - 2020/05/07/ PY - 2020/5/8/pubmed PY - 2021/9/3/medline PY - 2020/5/8/entrez KW - Social network analysis KW - mental health KW - opioid prescribing KW - opioids KW - substance use disorder SP - 301 EP - 310 JF - Journal of addictive diseases JO - J Addict Dis VL - 38 IS - 3 N2 - Background: Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines.Objectives: Examine associations between care networks defined by shared patients and problematic opioid prescribing.Methods: Analysis was at the provider-year level. Social network analysis (SNA) applied to the Medicaid MarketScan® Research Database for the years 2010-2015 identified care communities, each community's level of integration (centralization), and each provider's integration (centrality). Nested multivariable logistic regressions controlling for patient mix and provider specialty simultaneously examined the risk of any (incident) and repeated (prevalent) inappropriate prescribing.Outcomes: Four behaviors defined by the CDC guidelines were examined: (1) more than 90 days continuous supply of high-dose opioid analgesics for chronic pain, (2) overlapping opioid supplies, (3) overlapping opioid and benzodiazepine prescriptions, and (4) prescribing an extended release opioid for an acute pain diagnosis.Results: Provider centrality was associated with reduced incidence of outcome (2) (OR: 0.95) and decreased prevalence of outcomes (1), (2), and (3). However, higher incidence (OR: 1.32) and prevalence (OR: 1.027) of outcome (4) were observed. Conversely, centralization associated with decreased incidence of (1) and (2) and lower prevalence of (1), (2), and (3).Conclusions: Greater provider integration is associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription is more ambiguous. SN - 1545-0848 UR - https://www.unboundmedicine.com/medline/citation/32378481/Physician_networks_and_potentially_inappropriate_opioid_prescriptions_ L2 - https://www.tandfonline.com/doi/full/10.1080/10550887.2020.1760655 DB - PRIME DP - Unbound Medicine ER -