Health system data incompletely capture the social risk factors for drug overdose. This study aimed to improve the accuracy of a machine-learning algorithm to predict opioid overdose risk by ...integrating human services and criminal justice data with health claims data to capture the social determinants of overdose risk. This prognostic study included Medicaid beneficiaries (n = 237,259) in Allegheny County, Pennsylvania enrolled between 2015 and 2018, randomly divided into training, testing, and validation samples. We measured 290 potential predictors (239 derived from Medicaid claims data) in 30-day periods, beginning with the first observed Medicaid enrollment date during the study period. Using a gradient boosting machine, we predicted a composite outcome (i.e., fatal or nonfatal opioid overdose constructed using medical examiner and claims data) in the subsequent month. We compared prediction performance between a Medicaid claims only model to one integrating human services and criminal justice data with Medicaid claims (i.e., integrated model) using several metrics (e.g., C-statistic, number needed to evaluate NNE to identify one overdose). Beneficiaries were stratified into risk-score decile subgroups. The samples (training = 79,087, testing = 79,086, validation = 79,086) had similar characteristics (age = 38±18 years, female = 56%, white = 48%, having at least one overdose = 1.7% during study period). Using the validation sample, the integrated model slightly improved on the Medicaid claims only model (C-statistic = 0.885; 95%CI = 0.877-0.892 vs. C-statistic = 0.871; 95%CI = 0.863-0.878), with small corresponding improvements in the NNE and positive predictive value. Nine of the top 30 most important predictors in the integrated model were human services and criminal justice variables. Using the integrated model, approximately 70% of individuals with overdoses were members of the top risk decile (overdose rates in the subsequent month = 47/10,000 beneficiaries). Few individuals in the bottom 9 deciles had overdose episodes (0-12/10,000). Machine-learning algorithms integrating claims and social service and criminal justice data modestly improved opioid overdose prediction among Medicaid beneficiaries for a large U.S. county heavily affected by the opioid crisis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study examined health preference utility weights and utility decrements associated with different types of chronic conditions in the United States.
We used the 2010-2015 Medical Expenditure ...Panel Survey data for persons aged ≥ 18 years with 12-Item Short-Form Survey Physical and Mental Component Summary scores. 12-Item Short-Form Survey scores were converted to Short-Form Six-Dimension (SF-6D) preference scores to measure utilities of different chronic diseases. We used the Clinical Classification Code to identify 30 chronic diseases from 12 categories, such as cardiovascular diseases, cerebrovascular diseases, hypertension, hyperlipidemia, obesity, cancers, musculoskeletal diseases, endocrine or metabolic diseases, oral diseases, respiratory diseases, and mental disorders. A generalized linear model was used to quantify the utility decrements for 30 chronic diseases, controlling for demographic characteristics.
We identified 132 737 adults (mean age 47.2 years, 52.2% female, 80% white); 73% had at least one identified chronic disease, and the mean SF-6D was 0.786. Among 30 chronic diseases, the unadjusted mean SF-6D scores of patients with cognitive disorder (0.607) were the lowest, followed by congestive heart failure (0.629), rheumatoid arthritis (0.654), and lung cancer (0.662). After controlling for demographic variables (ie, age, sex) and comorbidities, cognitive disorders (−0.116), mood disorders (−0.099), rheumatoid arthritis (−0.090), liver cancer (−0.078), and stroke (−0.063) showed the highest decrements in the SF-6D scores (P < .05).
This study provides a nationally representative catalog of utility weights for major chronic diseases in the US general population. The utility decrements will enable researchers to calculate the health utilities of patients with multiple comorbid diseases.
The misuse of prescription medications in the United States is a worsening public health problem. Pharmacy technicians are often the first pharmacy staff member to receive newly dropped off ...prescriptions and to interact with patients in the pharmacy. Having a tool kit of the knowledge and skills needed to distinguish prescriptions that may result in misuse from the legitimate ones and to respond appropriately and professionally to each is essential to pharmacy technicians performing their role and function in the dispensing process.
The hepatitis C virus (HCV) epidemic remains a public health problem worldwide. A systematic review and meta-analysis were conducted to provide evidence of outcomes attained across the HCV care ...cascade in the era of direct-acting antivirals.
Studies from North America, Europe, and Australia (January 2014 through March 2021) reporting on HCV care cascade outcomes (screening to cure) were included. When calculating the proportions of individuals completing each step, the numerator for Steps 1-8 was the number of individuals completing each step; the denominator was the number of individuals completing the previous step for Steps 1-3 and Step 3 for Steps 4-8. In 2022, random effects meta-analyses were conducted to estimate pooled proportions with 95% CIs.
Sixty-five studies comprising 7,402,185 individuals were identified. Among individuals with positive HCV ribonucleic acid test results, 62% (95% CI=55%, 70%) attended their first care appointment, 41% (95% CI=37%, 45%) initiated treatment, 38% (95% CI=29%, 48%) completed treatment, and 29% (95% CI=25%, 33%) achieved cure. HCV screening rates were 43% (95% CI=22%, 66%) in prisons or jails and 20% (95% CI=11%, 31%) in emergency departments. Linkage to care rates were 62% (95% CI=46%, 75%) for homeless individuals and 26% (95% CI=22%, 31%) for individuals diagnosed in emergency departments. Cure rates were 51% (95% CI=30%, 73%) in individuals with substance use disorder and 17% (95% CI=17%, 17%) in homeless individuals. Cure rates were lowest in the U.S.
Despite the availability of effective all-oral direct-acting antiviral therapies, persistent gaps remain across the HCV care cascade, especially among traditionally marginalized populations. Public health interventions targeting identified priority areas (e.g., emergency departments) may improve screening and healthcare retention of vulnerable populations with HCV infection (e.g., substance use disorder populations).
Background and aims
Little is known about opioid and gabapentinoid (OPI‐GABA) use duration and dose patterns’ associations with adverse outcome risks. We examined associations between OPI‐GABA dose ...and duration trajectories and subsequent drug overdose.
Design
Retrospective cohort study.
Setting
US Medicare.
Participants
Using a 5% sample (2011–16), we identified 71 005 fee‐for‐service Medicare beneficiaries with fibromyalgia, low back pain, neuropathy and/or osteoarthritis initiating OPIs and/or GABAs mean age ± standard deviation (SD) = 65.5 ± 14.5 years, female = 68.1%, white = 76.8%.
Measurements
Group‐based multi‐trajectory models identified distinct OPI‐GABA use patterns during the year of OPI and/or GABA initiation, based on weekly average standardized daily dose (i.e. OPIs = morphine milligram equivalent, GABAs = minimum effective daily dose). We estimated models with three to 12 trajectories and selected the best model based on Bayesian information criterion (BIC) and Nagin's criteria. We estimated risk of time to first drug overdose diagnosis within 12 months following the index year, adjusting for socio‐demographic and health factors using inverse probability of treatment weighted multivariable Cox proportional hazards models.
Findings
We identified 10 distinct trajectories (BIC = –1 176 954; OPI‐only = 3, GABA‐only = 3, OPI‐GABA = 4). Compared with OPI‐only early discontinuers (40.6% of the cohort), 1‐year drug overdose risk varied by trajectory group: consistent low‐dose OPI‐only users 16.6%; hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.19–1.82, consistent high‐dose OPI‐only users (1.8%; HR = 4.57, 95% CI = 2.99–6.98), GABA‐only early discontinuers (12.5%; HR = 1.39, 95% CI = 1.09–1.77), consistent low‐dose GABA‐only users (11.0%; HR = 1.44, 95% CI = 1.12–1.85), consistent high‐dose GABA‐only users (3.1%; HR = 1.43, 95% CI = 0.94–2.17), early discontinuation of OPIs and consistent low‐dose GABA users (6.9%; HR = 1.24, 95% CI = 0.90–1.69), consistent low‐dose OPI‐GABA users (3.4%; HR = 2.49, 95% CI = 1.76–3.52), consistent low‐dose OPI and high‐dose GABA users (3.2%; HR = 2.46, 95% CI = 1.71–3.53) and consistent high‐dose OPI and moderate‐dose GABA users (0.9%; HR = 7.22, 95% CI = 4.46–11.69).
Conclusions
Risk of drug overdose varied substantially among US Medicare beneficiaries on different use trajectories of opioids and gabapentinoids. High‐dose opioid‐only users and all consistent opioid and gabapentinoid users (regardless of doses) had more than double the risk of subsequent drug overdose compared with opioid‐only early discontinuers.
The effects of all-oral direct-acting antivirals (DAAs) on hepatocellular carcinoma (HCC) and liver-related and all-cause mortality were assessed among Medicaid beneficiaries with hepatitis C virus ...(HCV).
This cohort study used 2013-2019 Arizona Medicaid data from beneficiaries with HCV aged 18-64 years.
Risks of HCC and liver-related and all-cause mortality were compared between patients with or without DAA treatment, stratified by liver disease severity, using inverse probability of treatment weighted multivariable Cox proportional hazards regression models.
Of 29,289 patients, 13.3% received DAAs. Among patients with compensated cirrhosis (CC), DAA treatment was associated with a lower risk of HCC adjusted hazard ratio (aHR), 0.57; 95% CI, 0.37-0.88 compared with untreated patients although this association was not statistically significant for patients without cirrhosis or with decompensated cirrhosis (DCC). Compared with untreated patients, DAA treatment was associated with decreased risk of liver-related mortality for patients without cirrhosis (aHR: 0.02; 95% CI: 0.004-0.11), with CC (aHR: 0.09; 95% CI: 0.06-0.13), or with DCC (aHR: 0.20; 95% CI: 0.14-0.27). Similarly, compared with untreated patients, DAA treatment was associated with lower all-cause mortality for patients without cirrhosis (aHR: 0.10; 95% CI: 0.08-0.14), with CC (aHR: 0.07; 95% CI: 0.05-0.10), or with DCC (aHR: 0.15; 95% CI: 0.11-0.20).
Among Arizona Medicaid beneficiaries with HCV, DAA treatment was associated with decreased risk of HCC for patients with CC but not for patients without cirrhosis or with DCC. However, DAA treatment was associated with decreased risk of liver-related and all-cause mortality.
Abstract
Background/Aims
Building on the success of NRAS’s New2RA Right Start service, and after speaking to families and healthcare professionals it was clear that there is a need for a New2JIA ...Right Start service. “Parents are given an overwhelming amount of information about a new disease, along with countless hospital appointments, blood tests, physio appointments and medication to administer. Add to the mix, trying to explain to your child (if they're old enough) what is going on with their joints and why they are in so much pain and discomfort when you don't really understand yourself! Parents have to deal with all of this, often trying to hold down their job and having other children to look after. Then there's the worry of how your child's future will look. New2JIA Right Start would have been my saviour and my husband’s too.” JIA Ambassador
Methods
Healthcare professionals will refer families to JIA-at-NRAS through a simple (GDPR compliant) form on our website. This is received by JIA-at-NRAS and a zoom call is arranged with up to 6 other families, also referred with children of similar ages. During the call, all aspects of JIA will be discussed, and parents will have the opportunity to ask questions. Families will have a follow up zoom call 10 weeks later to see how they are getting on. The service is being launched in phases throughout the UK, with phase 1 in November 2022, phase 2 in February 2023 and phase 3 in May 2023. Impact measurements will be imbedded to make sure that we are not only meeting the needs of the service user, but also having a positive impact to their lives, their children’s and ensuring they feel better equipped to manage their child’s condition.
Results
This new service not only benefits families but also healthcare professionals. The benefits to families are to: better understand what JIA is, know how it can affect their child and family, not feel alone during a daunting and overwhelming time, get the right support, feel more in control of managing their child’s condition, talk to another parent who has a child with JIA and access useful information resources. The benefits to healthcare professionals are: knowing families have support straight away (including peer-to-peer support), knowing that families are being given trusted information, reduced burden on their team and regular contact with JIA-at-NRAS.
Conclusion
Results from the Mental Health Survey, in collaboration with all other JIA charities in 2022, showed that 82% of families said having a child diagnosed with JIA has impacted negatively on their mental health. This service is there to help reduce these anxieties and give them the understanding and tools needed to help manage their child’s condition.
Disclosure
D. Wilson: None.
Abstract
Background/Aims
During conversations with parents, children and adults living with JIA, a common theme kept coming up which is ‘why can’t people understand that JIA is a fluctuating ...condition?’ It can be very frustrating to keep explaining this. Some days, those living with JIA are able to do most things e.g. play football, cook, go for a run. However other days it can be a struggle to even get out of bed or climb the stairs at school/work. Due to the lack of understanding of this disease some children have had people asking them if they are faking it. They have said, ‘We need to help teachers to understand how diverse and fluctuating the disease is from day to day, I’m not lying about my symptoms, they change’. Therefore, following the success of NRAS’s RA awareness weeks, it was decided we would run the first ever JIA Awareness Week on the theme that no two days are the same living with JIA, and the hashtag #SameJIADifferentDay was created.
Methods
NRAS does not have the resources to do major TV adverts, so we decided to make this a social media campaign. We wanted to have films/photos and content to educate and inform people of what it is like to live with JIA and how no two days are the same. Six films were created, three were from a teenager and three from an adult, both living with JIA. This helps to highlight that adults can be living with JIA as well; it is does not become RA when you are an adult. We launched a different film each day that week (https://jia.org.uk/youtube) Throughout the week, events took place, including: JoinTogether JIA Parent/Carer online group meeting, a Facebook Live Session in which Chloe Umpleby and Ellie Farr from NRAS’s Young Voices Panel shared their experiences of what a good day and bad day looks like for them. Pam Duncan-Glancy MSP living with JIA, put in a motion to the Scottish Government and she helped raise awareness throughout the week.
Results
On average, NRAS’s social media platforms’ engagements went up by 189%. The highest was Facebook which had a 386.5% increase in profile visits. Some of the feedback we received included: “This is important recognition that a condition diagnosed in early childhood can continue to impact on your life as an adult.” “Simple video that speaks volumes.” “I’m loving the social media post for #SameJIADifferentDay, that is exactly what my child is like.”
Conclusion
This was a successful campaign, not only in terms of post engagement and website visits but, as seen in the feedback above, in using video as a powerful tool to get across common misconceptions about JIA.
Disclosure
D. Wilson: None.
The objective of this study was to estimate the economic impact of providing universal hepatitis C virus testing in commercially insured middle-aged persons who inject drugs in the U.S.
This study ...developed a dynamic 10-year economic model to project the clinical and economic outcomes associated with hepatitis C virus testing among middle-aged adult persons who inject drugs, from a payer's perspective. Costs related to hepatitis C virus testing, direct-acting antiviral, and liver-related outcomes between the (1) current hepatitis C virus testing rate (i.e., 8%) and (2) universal hepatitis C virus testing rate (i.e., 100%) were compared. Among patients testing positive, 21% of those without cirrhosis and 48% of those with cirrhosis were assumed to initiate direct-acting antivirals. Sensitivity analyses were performed to identify variables (e.g., direct-acting antiviral drug costs, hepatitis C virus testing costs, direct-acting antiviral treatment rate) influencing this study's conclusion.
The model predicts that during the 10-year period, universal hepatitis C virus testing will cost an additional $242 per person who injects drugs to the payers’ healthcare budgets compared with the current scenario. Sensitivity analyses showed values ranging from $1,656 additional costs to $1,085 cost savings across all varied parameters and scenarios. A total of 80% of the current direct-acting antiviral costs indicated that cost savings will be $383 per person who injects drugs.
Universal hepatitis C virus testing among persons who inject drugs would not achieve cost savings within 10 years, with the cost of direct-acting antivirals contributing the most to the spending. To promote universal hepatitis C virus testing among persons who inject drugs, decreasing direct-acting antiviral costs and sustainable funding streams for hepatitis C virus testing should be considered.
Endocrine therapy is the mainstay treatment for breast cancer (BC) to reduce BC recurrence risk. During the first year of endocrine therapy use, nearly 30% of BC survivors are nonadherent, which may ...increase BC recurrence risk. This study is to examine the association between endocrine therapy adherence trajectories and BC recurrence risk in nonmetastatic BC survivors.
This retrospective cohort study included Medicare beneficiaries in the United States (US) with incident nonmetastatic BC followed by endocrine therapy initiation in 2010-2019 US Surveillance, Epidemiology, and End Results linked Medicare data. We calculated monthly fill-based proportion of days covered in the first year of endocrine therapy. We applied group-based trajectory models to identify distinct endocrine therapy adherence patterns. After the end of the first-year endocrine therapy trajectory measurement period, we estimated the risk of time to first treated BC recurrence within 4 years using Cox proportional hazards models.
We identified 5 trajectories of adherence to endocrine therapy in BC Stages 0-I subgroup (n = 28,042) and in Stages II-III subgroup (n = 7781). A trajectory of discontinuation before 6 months accounted for 7.0% in Stages 0-I and 5.8% in Stages II-III subgroups, and this trajectory was associated with an increased treated BC recurrence risk compared to nearly perfect adherence (Stages 0-I: adjusted hazard aHR = 1.84, 95% CI = 1.46-2.33; Stages II-III: aHR = 1.38, 95% CI = 1.07-1.77).
Nearly 7% of BC survivors who discontinued before completing 6 months of treatment was associated with an increased treated BC recurrence risk compared to those with nearly perfect adherence among Medicare nonmetastatic BC survivors.
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