Prescription Opioid Quality Measures Applied among Pennsylvania Medicaid Enrollees

Details

• Alternative Title:
  J Manag Care Spec Pharm
• Personal Author:
  Cochran, Gerald ; Lo-Ciganic, Wei-Hsuan ; Gellad, Walid F. ; Gordon, Adam J. ; Cole, Evan ; Lobo, Carroline ; Frazier, Winfred ; Zheng, Ping ; Chang, Chung-Chou H. ; Kelley, David ; Donohue, Julie M.
• Description:
  Background:
  
  The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for opioid prescribing: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines.
  
  Objective:
  
  Our objective was 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 non-cancer patients who were aged 18–64, and not dually Medicare/Medicaid eligible. Per PQA specifications, patients were required to possess ≥2 opioid prescriptions for ≥15 days annual supply each year. Outcome measures included: high dosages, defined as >120 morphine milligram equivalents for ≥90 consecutive days; multiple providers/pharmacies, defined as receiving opioid prescriptions from ≥4 providers and ≥4 pharmacies; and concurrent use of opioids and benzodiazepines, defined as ≥30 cumulative days of overlapping opioids and benzodiazepines among individuals having ≥2 opioids 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 2013–2015, high dosage prevalence increased from 5.1 to 5.5%; 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 2013–2015 were Medicaid eligible 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), and 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 supports to care for the population identified by these measures.
  
  
• Subjects:
  Adolescent Adult Analgesics, Opioid Article Cohort Studies Cross-Sectional Studies Female Humans Male Medicaid Middle Aged Opioid-Related Disorders Pennsylvania Quality Of Health Care United States Young Adult

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• Source:
  J Manag Care Spec Pharm. 24(9):875-885
• Pubmed ID:
  30156454
• Pubmed Central ID:
  PMC6418411
• Document Type:
  Journal Article
• Funding:
  U01 CE002496/CE/NCIPC CDC HHS/United States
• Volume:
  24
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:5d2e21a78bdb317704e830c0be33ab4ee2c48d05112e0d7f95725cc50e71d00e
• Download URL:
  https://stacks.cdc.gov/view/cdc/76540/cdc_76540_DS1.pdf
• File Type:
  [PDF - 110.03 KB ]