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An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician

BACKGROUND: Insurance status may influence quality of opioid analgesic (OA) prescribing among patients seen by the same clinician. OBJECTIVE: To explore how high-risk OA prescribing varies by payer type among patients seeing the same prescriber and identify clinician characteristics associated with...

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Autores principales: Schulson, Lucy B., Dick, Andrew, Sheng, Flora, Stein, Bradley D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212884/
https://www.ncbi.nlm.nih.gov/pubmed/36745303
http://dx.doi.org/10.1007/s11606-023-08025-6
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author Schulson, Lucy B.
Dick, Andrew
Sheng, Flora
Stein, Bradley D.
author_facet Schulson, Lucy B.
Dick, Andrew
Sheng, Flora
Stein, Bradley D.
author_sort Schulson, Lucy B.
collection PubMed
description BACKGROUND: Insurance status may influence quality of opioid analgesic (OA) prescribing among patients seen by the same clinician. OBJECTIVE: To explore how high-risk OA prescribing varies by payer type among patients seeing the same prescriber and identify clinician characteristics associated with variable prescribing DESIGN: Retrospective cohort study using the 2016–2018 IQVIA Real World Data – Longitudinal Prescription PARTICIPANTS: New OA treatment episodes for individuals ≥ 12 years, categorized by payer and prescriber. We created three dyads: prescribers with ≥ 10 commercial insurance episodes and ≥ 10 Medicaid episodes; ≥ 10 commercial insurance episodes and ≥ 10 self-pay episodes; and ≥ 10 Medicaid episodes and ≥ 10 self-pay episodes. MAIN OUTCOME(S) AND MEASURE(S): Rates of high-risk episodes (initial opioid episodes with > 7-days’ supply or prescriptions with a morphine milliequivalent daily dose >90) and odds of being an unbalanced prescriber (prescribers with significantly higher percentage of high-risk episodes paid by one payer vs. the other payer) KEY RESULTS: There were 88,352 prescribers in the Medicaid/self-pay dyad, 172,392 in the Medicaid/commercial dyad, and 122,748 in the self-pay/commercial dyad. In the Medicaid/self-pay and the commercial-self-pay dyads, self-pay episodes had higher high-risk episode rates than Medicaid (16.1% and 18.4%) or commercial (22.7% vs. 22.4%). In the Medicaid/commercial dyad, Medicaid had higher high-risk episode rates (21.1% vs. 20.4%). The proportion of unbalanced prescribers was 11–12% across dyads. In adjusted analyses, surgeons and pain specialists were more likely to be unbalanced prescribers than adult primary care physicians (PCPs) in the Medicaid/self-paydyad (aOR 1.2, 95% CI 1.16–1.34 and aOR 1.2, 95% CI 1.03–1.34). For Medicaid/commercial and self-pay/commercial dyads, surgeons had lower odds of being unbalanced compared to PCPs (aOR 0.6, 95% CI 0.57–0.66 and aOR 0.6, 95% CI 0.61–0.68). CONCLUSIONS: Clinicians prescribe high-risk OAs differently based on insurance type. The relationship between insurance and opioid prescribing quality goes beyond where patients receive care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-023-08025-6.
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spelling pubmed-102128842023-05-27 An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician Schulson, Lucy B. Dick, Andrew Sheng, Flora Stein, Bradley D. J Gen Intern Med Original Research BACKGROUND: Insurance status may influence quality of opioid analgesic (OA) prescribing among patients seen by the same clinician. OBJECTIVE: To explore how high-risk OA prescribing varies by payer type among patients seeing the same prescriber and identify clinician characteristics associated with variable prescribing DESIGN: Retrospective cohort study using the 2016–2018 IQVIA Real World Data – Longitudinal Prescription PARTICIPANTS: New OA treatment episodes for individuals ≥ 12 years, categorized by payer and prescriber. We created three dyads: prescribers with ≥ 10 commercial insurance episodes and ≥ 10 Medicaid episodes; ≥ 10 commercial insurance episodes and ≥ 10 self-pay episodes; and ≥ 10 Medicaid episodes and ≥ 10 self-pay episodes. MAIN OUTCOME(S) AND MEASURE(S): Rates of high-risk episodes (initial opioid episodes with > 7-days’ supply or prescriptions with a morphine milliequivalent daily dose >90) and odds of being an unbalanced prescriber (prescribers with significantly higher percentage of high-risk episodes paid by one payer vs. the other payer) KEY RESULTS: There were 88,352 prescribers in the Medicaid/self-pay dyad, 172,392 in the Medicaid/commercial dyad, and 122,748 in the self-pay/commercial dyad. In the Medicaid/self-pay and the commercial-self-pay dyads, self-pay episodes had higher high-risk episode rates than Medicaid (16.1% and 18.4%) or commercial (22.7% vs. 22.4%). In the Medicaid/commercial dyad, Medicaid had higher high-risk episode rates (21.1% vs. 20.4%). The proportion of unbalanced prescribers was 11–12% across dyads. In adjusted analyses, surgeons and pain specialists were more likely to be unbalanced prescribers than adult primary care physicians (PCPs) in the Medicaid/self-paydyad (aOR 1.2, 95% CI 1.16–1.34 and aOR 1.2, 95% CI 1.03–1.34). For Medicaid/commercial and self-pay/commercial dyads, surgeons had lower odds of being unbalanced compared to PCPs (aOR 0.6, 95% CI 0.57–0.66 and aOR 0.6, 95% CI 0.61–0.68). CONCLUSIONS: Clinicians prescribe high-risk OAs differently based on insurance type. The relationship between insurance and opioid prescribing quality goes beyond where patients receive care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-023-08025-6. Springer International Publishing 2023-02-06 2023-05 /pmc/articles/PMC10212884/ /pubmed/36745303 http://dx.doi.org/10.1007/s11606-023-08025-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Research
Schulson, Lucy B.
Dick, Andrew
Sheng, Flora
Stein, Bradley D.
An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title_full An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title_fullStr An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title_full_unstemmed An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title_short An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician
title_sort exploratory analysis of differential prescribing of high-risk opioids by insurance type among patients seen by the same clinician
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10212884/
https://www.ncbi.nlm.nih.gov/pubmed/36745303
http://dx.doi.org/10.1007/s11606-023-08025-6
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