Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data (original) (raw)
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Validation of the University of Manchester Drug Misuse Database
Journal of Epidemiology & Community Health, 1999
Objective-The study was conducted to assess the validity and quality of data held by one of the UK regional drug misuse databases (DMD). Design-The research was multi-centred and used retrospective analysis to assess the validity of data held on the database. Setting-The Regional Database is managed at the University of Manchester Drug Misuse Research Unit and uses data returned by medical and non-medical services within the UK's former North Western Regional Health Authority. Material-The research was largely based on analysis of the reporting or nonreporting to DMD of 1526 presentations by drug users to four community drug teams (CDTs) during the course of 1993. Two datasets were used: the DMD dataset, based on returns to the regional database from the agencies in question; and agency client records. Additionally the data included on a random sample of 300 database forms returned by these CDTs were compared with information contained in client records. Main outcome measures-the study reports on how well DMD is functioning in relation to the correct reporting of episodes of problem drug use and the quality of data held. Results-A very high level of agreement (0.875 ±0.017, 95% CI, coeYcient 0.728) was established between reports sent in to the database and those expected by examination of agency records. The database figures underestimated the total number of episodes that should have been reported by a factor of 0.008. It was also established that 0.906 (±0.018, 95% CI) of the reports made to the database were made correctly, that 0.178 (±0.030, 95% CI) of eligible presentations were not reported, and that 0.166 (±0.030, 95% CI) of ineligible presentations were mistakenly reported. Lastly, it was established that data were unnecessarily missing or inaccurately recorded in 0.027 of cases and that data entry errors occurred in 0.015 of cases.
A Patient-Based Analysis of Drug Disorder Diagnoses in the Medicare Population
Health Care Financing Review, 1993
This article utilizes the Part A Medicare provider analysis and review (MEDPAR) file for fiscal year (FY) 1987. The discharge records were organized into a patient-based record that included alcohol, drug, and mental (ADM) disorder diagnoses as well as measures of resource use. The authors find that there are substantially higher costs of health care incurred by the drug disorder diagnosed population. Those of the Medicare population diagnosed with drug disorders had longer lengths of stay (LOSs), higher hospital charges, and more discharges. Costs increased monotonically as the number of drug diagnoses increased. Overlap of mental and alcohol problems is presented for the drug disorder diagnosed population.
Drug and Alcohol Dependence, 2010
Administrative data provide a rich resource for improving our understanding of individuals with substance use disorders. The validation of administrative proxies for moderate or high risk alcohol or drug (AOD) use could enhance the ability to carry out rigorous observational research (for example, for use in the construction of comparison groups). This study used receiver operating characteristic (ROC) curve techniques to assess how well AOD-related administrative indicators predicted self-reported AOD use obtained from AUDIT/DAST screening scores. An administrative AOD indicator, derived from a combination of medical encounter and billing data, arrest records, and publicly funded AOD-related services data, demonstrated discrimination in the acceptable range (AUC: 0.72-0.78) for identifying self-reported AOD use consistent with potential need for either (1) any AOD-related intervention, or (2) intensive AOD-related intervention or treatment. These findings held up in two distinct samples: a statewide Medicaid-only sample and a single-site mixed-payer sample that included the uninsured. Our findings suggest that indicators of AOD-related problems derived from administrative data can be useful for identifying moderate or high risk AOD use in a research context. The findings further suggest that proxies for substance use disorders, such as those evaluated here, can enhance future observational studies intended to improve health care for this population.
Journal of addiction medicine, 2018
ASAM's Standards of Care for the Addiction Specialist established appropriate care for the treatment of substance use disorders. ASAM identified three high priority performance measures for specification and testing for feasibility in various systems using administrative claims: use of pharmacotherapy for alcohol use disorder (AUD); use of pharmacotherapy for opioid use disorder (OUD); and continuity of care after withdrawal management services. This study adds to the initial testing of these measures in the Veteran's Health Administration (VHA) by testing the feasibility of specifications in commercial insurance data (Cigna). Using 2014 and 2015 administrative data, the proportion of individuals with an AUD or OUD diagnosis each year who filled prescriptions or were dispensed appropriate FDA-approved pharmacotherapy. For withdrawal management follow up, the proportion with an outpatient encounter within seven days was calculated. The sensitivity of specifications was also t...
July 2002, 2002
Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedative-hypnotics play a significant and legitimate role in managing chronic pain, anxiety, depression, insomnia and muscle spasm. However, considerable controversy exists about the use of not only opioids but also other controlled substances for management of chronic pain of noncancer origin. The abuse of prescription controlled drugs is one facet of America's drug problem that is particularly complex because access to prescription drugs must be maintained for legitimate medical purposes. McLellan et al (1) described that many expensive and disturbing social problems can be traced directly to drug dependence. Due to their abuse potential, opioids, benzodiazepines, and other controlled substances are extensively regulated and become an issue for interventional pain physicians and their patients. Based on the 1997 Household Survey on Drug Abuse, it is estimated that 76.9 million Americans, age 12 and older, had used an illicit drug at least once in their lives (2). This represents 36.6% of the nation's household population age 12 and older. Further, over 24 million or 30% of this population reported they used an illicit drug at least once in the year prior to the interview and approximately 14 million or 17% of the population reported using an illicit drug in the month prior to interview. Based on the 1997 survey, 4.2 million people used analgesics, 2.1 million people used tranquilizers, and an additional 2.3 million people used various other drugs, including sedatives, tranquilizers, etc. In addition, the survey also indicated that the non-medical use of prescription drugs exceeds that of all illicit substances except for marijuana and The National All Schedules Prescription Electronic Reporting Act, or NASPER, is a bill proposed by the American Society of Interventional Pain Physicians to provide and improve patient access with quality care, and protect patients and physicians from deleterious effects of controlled substance misuse, abuse and trafficking. Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedativehypnotics play a significant and legitimate role in interventional pain management practices in managing chronic pain and related disorders. Based on the 1997 household survey on drug abuse it is estimated that 76.9 million Americans had used an illicit drug at least once in their life. In 1997, 4.2 million people used analgesics, 2.1 million used tranquillizers, and an additional 2.3 million people used various other drugs, including sedatives, tranquillizers, etc. The non-medical use of prescription drugs exceeds that of all illicit on epidemiology trends in drug abuse, based on community epidemiology work group analysis showed continued increase of abuse of prescription drugs in urban, suburban, and rural areas. The most commonly abused drugs include oxycodone, hydrocodone, hydromorphone, morphine, codeine, clonazepam, alprazolam, lorazepam, diazepam and carisoprodol. The diversion of prescription controlled substances to illicit channels is a public health and safety issue. This review describes the role of controlled substances in chronic pain management, prevalence and economic impact of controlled substance abuse, prescription accountability, effectiveness of prescription monitoring programs, and rationale for national controlled substance electronic reporting system.
Prescribing and pharmacotherapeutics
Context: Primary care providers are on the front line of the opioid crisis attempting to appropriately prescribe opioids and provide compassionate care. Providers are in a difficult position and often need the counsel from those in pain management, addiction medicine and medication tapering. This has led to the development of a multidisciplinary Controlled Substance Advisory Group (CSAG) in 2016 at our institution comprising 9 members: 5 from primary care (2 clinicians, 1 pharmacist, 2 nurses); 1 pain specialist; 1 psychiatrist; and 2 pain rehabilitation providers (1 psychologist, 1 pharmacist). Having an outside group review cases and provide recommendations allows providers to preserve their relationship with patients. Objectives: (1) To assess the characteristics of a sample of cases reviewed by CSAG from January 2019 to March 2021 (2) To evaluate the perceived usefulness of the case review process. Study Design: Retrospective review of referred cases. Surveys were sent to referring providers after the review. Setting: Primary care clinics within Mayo Clinic and Mayo Clinic Health Systems in Minnesota. Population: Patients on controlled substances not in hospice and without an active cancer diagnosis. Post-review surveys were sent to referring providers. Intervention: Referring providers are invited to a real-time case review. Recommendations are entered into patients' health records. Providers are asked to complete an anonymized post-review survey. Outcome measures: Cases reviewed categorized into referral sources, types of controlled substance of concern, and review recommendations; feedback from referring providers. Results: A sample of 72 cases from January 2019 to March 2021 were analyzed: 41% referrals came from physicians, 13% from advanced practice providers, 46% from practice leadership. 94% cases included opioids. Recommendations for 78% of cases included discontinuation/tapering; in the remaining 22%, CSAG recommended starting, restarting, or continuing a controlled substance. CSAG provided recommendations regarding noncontrolled adjuncts in 39% of cases. In 32% of cases, CSAG recommended naloxone. 85% referring providers were able to implement most of the recommendations, 79% reported that the review was helpful in preserving provider-patient relationship, 95% would refer cases again and would recommend CSAG to colleagues. Conclusions: CSAG allows providers to have easier access to specialists while preserving relationship with patients.
Prospective validation of substance abuse severity measures from administrative data
Drug and Alcohol Dependence, 2007
Background: Severity measures for clients in substance abuse treatment programs are becoming increasingly important as funders adopt payment systems linked to agency performance. Recently, two severity measures based on administrative data have been developed. This study validated these measures using prospective data. Methods: Subjects were participants in the Drug Abuse Treatment Outcomes Study (adult or adolescent components) or the Substance Abuse and Mental Health Services Administration Medicaid Managed Behavioral Healthcare and Vulnerable Populations project (adult or adolescent chemical dependency components). Severity measures were calculated based on data obtained at entry into substance abuse treatment. The baseline severity measures were included along with age, gender, and race/ethnicity in logistic regression models predicting abstinence at follow-up for alcohol use, marijuana use, cocaine use, or heroin use. Results: For adults, the severity measures were highly statistically significant (p < 0.001) for all models in both data sets, indicating that adults with higher severity were more likely (and much more likely in many cases) to use alcohol, marijuana, cocaine, or heroin at the follow-up interview than were those with lower severity. For adolescents, the severity measure was highly statistically significant (p < 0.001) for marijuana in both data sets and for alcohol in the Medicaid data set. Conclusions: Baseline severity measures were powerful predictors of abstinence at follow-up. These measures, derived from routinely available electronic records, appear to have noteworthy predictive validity. The severity indicators can be used for administrative purposes such as riskadjustment when examining treatment agency performance.
Journal of Substance Abuse Treatment, 2017
Hospitalized patients have high rates of unhealthy substance use, which has important impacts on health both during and after hospitalization, but is infrequently identified in the absence of screening. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify use of tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs, and was previously validated in primary care patients. This study assessed the diagnostic accuracy of the SUBS in comparison to longer screening instruments to identify unhealthy and high-risk alcohol and drug use in hospitalized current smokers. Participants were 439 patients, aged 18 and older, who were admitted to either two urban safety-net hospitals in New York City and enrolled in a smoking cessation trial. We measured the performance of the SUBS for identifying illicit drug and non-medical use of prescription drugs in comparison to a modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and its performance for identifying excessive alcohol use in comparison to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). At the standard cutoff (response other than 'never' indicates a positive screen), the SUBS had a sensitivity of 98% (95% CI 95-100%) and specificity of 61% (95% CI 55-67%) for unhealthy alcohol use, a sensitivity of 85% (95% CI 80-90%) and specificity of 75% (95% CI 78-87%) for illicit drug use, and a sensitivity of 73% (95% CI 61-83%) and specificity of 83% (95% CI 78-87%) for prescription drug non-medical use. For identifying high-risk use, a higher cutoff (response of '3 or more days' of use indicates a positive screen), the SUBS retained high sensitivity (77-90%), and specificity was 62-88%. The SUBS can be considered as an alternative to longer screening instruments, which may fit more easily into busy inpatient settings. Further study is needed to evaluate its validity using gold standard measures in hospitalized populations.
Declared and undeclared substance use among emergency department patients: a population-based study
Addiction, 2006
Aims To estimate both self-reported and corrected prevalences of substance use in a population-based study of general hospital emergency department (ED) patients and predict undeclared use. Design A state-wide cross-sectional, two-stage probability sample survey that incorporates toxicological screening. Setting Seven Tennessee EDs in acute care, adult, civilian, non-psychiatric hospitals. Participants A total of 1502 Tennessee residents, 18 years of age and older, possessing intact cognition, able to give informed consent and not in police custody. Measurements Prevalence of self-reported current substance use by age, sex and type with correction for underreporting based on toxicological screening. Covariates in the multivariate analysis of undeclared use were sociodemographics, ED visit circumstances, health-care coverage, prior health status and treatment history and tobacco addiction. Findings Declared current use was highest for alcohol (females 26%, males 47%), marijuana (males 11%, females 6%) and benzodiazepines (females 10%, males 7%). After correction for under-reporting, overall use for any of the eight targeted substances rose from 44% to 56% for females and 61% to 69% for males. Largest absolute changes involved opioids, benzodiazepines, marijuana, amphetamines and/or methamphetamine, with little change for alcohol. Patients aged 65 years and older manifested excess undeclared use relative to patients aged 18-24 years, as did patients not reporting tobacco addiction or receiving substance abuse treatment. Conclusion Adjustment for under-reporting produced minimal change in the estimated prevalence of alcohol use. However, toxicological screening markedly increased estimates of other drug use, especially for the elderly, who may under-report medication use. Screening tests are useful tools for detecting undeclared substance use.