Prescription opioid quality measures applied among Pennsylvania medicaid enrollees

Gerald Cochran, Wei Hsuan Lo-Ciganic, Walid F. Gellad, Adam J. Gordon, Evan Cole, Carroline Lobo, Winfred Frazier, Ping Zheng, Chung Chou H. Chang, David Kelley, Julie M. Donohue

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines. OBJECTIVE: 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 noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess = 2 opioid prescriptions for = 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for = 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from = 4 providers and = 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as = 30 cumulative days of overlapping opioids and benzodiazepines among individuals having = 2 opioid 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 to 2015, high dosage prevalence increased from 5.1% to 5.5%; the use of 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 to 2015 was eligible for Medicaid 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). 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 support to care for this patient population.

Original languageEnglish (US)
Pages (from-to)875-885
Number of pages11
JournalJournal of Managed Care and Specialty Pharmacy
Volume24
Issue number9
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

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Medicaid
Opioid Analgesics
Prescriptions
Benzodiazepines
Pharmacies
Odds Ratio
Anxiety
Health
Demography
Statistical Data Interpretation
Medicare
Anxiety Disorders
Mood Disorders
Morphine
Comorbidity
Patient Care
Mental Health
Cross-Sectional Studies
Outcome Assessment (Health Care)
Specifications

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science
  • Health Policy

Cite this

Cochran, G., Lo-Ciganic, W. H., Gellad, W. F., Gordon, A. J., Cole, E., Lobo, C., ... Donohue, J. M. (2018). Prescription opioid quality measures applied among Pennsylvania medicaid enrollees. Journal of Managed Care and Specialty Pharmacy, 24(9), 875-885. https://doi.org/10.18553/jmcp.2018.24.9.875

Prescription opioid quality measures applied among Pennsylvania medicaid enrollees. / 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.

In: Journal of Managed Care and Specialty Pharmacy, Vol. 24, No. 9, 01.09.2018, p. 875-885.

Research output: Contribution to journalArticle

Cochran, G, Lo-Ciganic, WH, Gellad, WF, Gordon, AJ, Cole, E, Lobo, C, Frazier, W, Zheng, P, Chang, CCH, Kelley, D & Donohue, JM 2018, 'Prescription opioid quality measures applied among Pennsylvania medicaid enrollees', Journal of Managed Care and Specialty Pharmacy, vol. 24, no. 9, pp. 875-885. https://doi.org/10.18553/jmcp.2018.24.9.875
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. / Prescription opioid quality measures applied among Pennsylvania medicaid enrollees. In: Journal of Managed Care and Specialty Pharmacy. 2018 ; Vol. 24, No. 9. pp. 875-885.
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abstract = "BACKGROUND: The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines. OBJECTIVE: 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 noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess = 2 opioid prescriptions for = 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for = 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from = 4 providers and = 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as = 30 cumulative days of overlapping opioids and benzodiazepines among individuals having = 2 opioid 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 to 2015, high dosage prevalence increased from 5.1{\%} to 5.5{\%}; the use of 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 to 2015 was eligible for Medicaid 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). 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 support to care for this patient population.",
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AU - Cochran, Gerald

AU - Lo-Ciganic, Wei Hsuan

AU - Gellad, Walid F.

AU - Gordon, Adam J.

AU - Cole, Evan

AU - Lobo, Carroline

AU - Frazier, Winfred

AU - Zheng, Ping

AU - Chang, Chung Chou H.

AU - Kelley, David

AU - Donohue, Julie M.

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N2 - BACKGROUND: The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines. OBJECTIVE: 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 noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess = 2 opioid prescriptions for = 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for = 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from = 4 providers and = 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as = 30 cumulative days of overlapping opioids and benzodiazepines among individuals having = 2 opioid 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 to 2015, high dosage prevalence increased from 5.1% to 5.5%; the use of 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 to 2015 was eligible for Medicaid 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). 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 support to care for this patient population.

AB - BACKGROUND: The Pharmacy Quality Alliance (PQA) recently developed 3 quality measures for prescribing opioids: high dosages, multiple providers and pharmacies, and concurrent use of opioids and benzodiazepines. OBJECTIVE: 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 noncancer patients who were aged 18-64 years and not dual-eligible for Medicare/Medicaid. Per PQA specifications, patients were required to possess = 2 opioid prescriptions for = 15 days annual supply each year. Outcome measures included (a) high dosages, defined as > 120 morphine milligram equivalents for = 90 consecutive days; (b) multiple providers/pharmacies, defined as receiving opioid prescriptions from = 4 providers and = 4 pharmacies; and (c) concurrent use of opioids and benzodiazepines, defined as = 30 cumulative days of overlapping opioids and benzodiazepines among individuals having = 2 opioid 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 to 2015, high dosage prevalence increased from 5.1% to 5.5%; the use of 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 to 2015 was eligible for Medicaid 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). 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 support to care for this patient population.

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