scholarly journals Opioid Prescription Filling Trends Among Children with Sickle Cell Disease After the Release of State-Issued Guidelines on Pain Management

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2583-2592
Author(s):  
Susan E Creary ◽  
Deena J Chisolm ◽  
Sharon K Wrona ◽  
Jennifer N Cooper
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Filling Rate ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Acute Health Care

Abstract Objective To assess the impact of Ohio’s 2012, 2013, and 2016 opioid prescribing guidelines on opioid and nonsteroidal anti-inflammatory drug (NSAID) prescription filling and health care utilization for pain among children with sickle cell disease (SCD). Design Quasi-experimental retrospective cohort study. Setting Ohio Medicaid claims data from August 2011 to August 2016. Subjects Medicaid beneficiaries under age 19 years with SCD. Methods Interrupted time series analyses comparing population-level rates of opioids and NSAID prescriptions filled, standardized amounts of opioids dispensed, and acute health care utilization for pain before and after release of each guideline. Results In our cohort of 1,505 children with SCD, there was a temporary but significant decrease in the opioid filling rate (–2.96 prescriptions per 100 children, P = 0.01) and in the amount of opioids dispensed (–31.39 milligram morphine equivalents per filled prescription, P < 0.001) after the 2013 guideline but a temporary but significant increase in the opioid filling rate (7.44 prescriptions per 100 children, P < 0.001) and in the amount of opioids dispensed (72.73 mg morphine equivalents per filled prescription, P < 0.001) after the 2016 guideline. The NSAID filling rate did not significantly change after any of the guidelines. Acute health care utilization rates for pain after the 2016 guideline were similar to those before the 2013 guideline (rate ratio = 1.04, P = 0.63). Conclusions Our results suggest that Ohio’s 2013 and 2016 guidelines were associated with significant but nonsustained changes in opioid prescription filling among children with SCD. Additional studies are needed to confirm that opioid guidelines have a sustained impact on excessive opioid prescribing, filling, and misuse.

scholarly journals Outpatient Pain Predicts Subsequent One-Year Acute Health Care Utilization Among Adults With Sickle Cell Disease

2014 ◽  
Vol 48 (1) ◽  
pp. 65-74 ◽  
Author(s):  
Miriam O. Ezenwa ◽  
Robert E. Molokie ◽  
Zaijie Jim Wang ◽  
Yingwei Yao ◽  
Marie L. Suarez ◽  
...  
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Acute Health Care ◽  
One Year

Acute Healthcare Utilization for Patients with Sickle Cell Disease within a Community Based Hospital System

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4246-4246
Author(s):  
Hung Tran ◽  
Susan Claster ◽  
Paula K. Groncy ◽  
Theodore Zwerdling ◽  
Susan Shannon ◽  
...  
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Acute Care ◽  
Sickle Cell ◽  
Clinical Care ◽  
Care Utilization ◽  
Cell Disease ◽  
Public Insurance ◽  
Acute Health Care

Abstract Abstract 4246 Background: Analysis of administrative databases indicates high acute health care utilization in 18 to 30 year old patients with sickle cell disease (SCD). Thirty-day re-hospitalization rates are higher in SCD than any other disease studied. Administrative databases may misrepresent clinical care due to coding errors. We undertook a study of acute health care utilization in a community-based healthcare system that provides comprehensive pediatric sickle cell care up to age 21 years of age, but without a dedicated adult clinic in place. Methods: This study is a retrospective chart review (1/1/2009-12/31/2010) using discharge ICD-9-CM codes for sickle cell disease in primary or secondary diagnoses at Long Beach Memorial Medical Center/Miller Children's Hospital. To assess clinical care for SCD in our community, we examined 14- and 30-day readmissions and Emergency Department (ED) encounters following an index admission. Results: We identified 174 unique patients and 563 acute care encounters (readmission plus ED visits). Median patient age was 15 years (range 7 days to 65 years). There was a female predominance (96 female;78 male). Insurance coverage distribution overall was 67.5% public, 26.6% private, 3.9 % uninsured, and 0.5% unknown. The percent of patients with at least one 14-day and one 30-day readmission was 7.2% and 14.5% of those 10 or less (n=55), 10.9% and 16.4% of those 11–20 (n=55), 41.0% and 51.3% of 21–30 year old (n=39), and 16% and 28% of those over age 30 years (n=25). The ED treat and release rate within 14 days of discharge from an inpatient hospitalization was 9.5% of acute care encounters and occurred entirely in the over 30 yr old population. The overall rate within 30 days was 9.9% (6.3% acute care encounters in </= 10 yr olds, 0% 11 to 20, 2.5% 21–30, and 14% for over 30 year olds). The median number of 30-day acute care encounters for the entire population per patient per year was 1.62; 1.22 in </= 10 yr olds, 1.28 for 11–21 yr olds, 2.41 for 21–30 yr olds, and 2.0 for those over 30 yrs old. A few patients (5.2%) had 11+ encounters in a two-year period – the majority (67%) were 21–30 years old. Acute care encounters per patient per year in public vs. privately insured patients were: 1.30 and 0.95 for ages </= 10 yrs (80.0% public insurance), 1.27 and 1.32 for ages 11–20 (58.2% public insurance), 2.70 and 1.69 for ages 21–30 (74.4% public insurance), and 2.77 and 1.20 for those over 30 years old (60% public insurance). The six uninsured patients (1 each 11–20 and 21–30 yrs old, 4 >30 yrs old) had 1.2 encounters/patient/year. Length of stay and discharge diagnoses did not differ between the index admission and readmission in any age group. Acute care encounters within 30 days vs. index hospitalization were due to pain (90% vs. 92%), surgery (3.1% vs. 3.7%), acute chest syndrome (2.5% vs. 1.9%), childbirth (1.8% vs.0%), and for other reasons (2.5%, 2.5%). Conclusions: We confirmed previous database studies that the highest rate of 14- and 30-day readmission and the highest number of acute care encounters/patient/year occurs in 21–30 year olds. A small number of patients, the majority aged 21–30 years, account for >11 encounters in the two-year study period. There were more encounters for 21–30 and 31+ year olds for those publicly vs. privately insured. There was minimal use of the ED to treat and release following a hospital discharge in SCD patients under the age of 31. Dissecting the multiple reasons for the high number of encounters and rehospitalizations may result in decreasing acute health care utilization by persons with SCD, especially for patients greater than 21years old. Disclosures: No relevant conflicts of interest to declare.

Quality Metrics and Health Care Utilization for Adult Patients with Sickle Cell Disease

2019 ◽  
Vol 111 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Monica Ter-Minassian ◽  
Sophie Lanzkron ◽  
Alphonse Derus ◽  
Elizabeth Brown ◽  
Michael A. Horberg
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Quality Metrics ◽  
Adult Patients ◽  
Care Utilization ◽  
Cell Disease

Occupational History For Adults With Sickle Cell Disease Compared With Healthy Siblings

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2244-2244 ◽  
Author(s):  
Modupe Idowu ◽  
Omotayo Fawibe ◽  
Paul Rowan ◽  
Harinder S. Juneja ◽  
Deborah Brown
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Negative Impact ◽  
Care Utilization ◽  
Job Retention ◽  
Cell Disease ◽  
Healthy Siblings ◽  
Health Related

Abstract Introduction Sickle cell disease (SCD) has a negative impact on academic and job functioning. Recurrent acute vaso-occlusive crises and organ dysfunction related to SCD can limit employment options and interfere with job retention. Potential associates of unemployment and poor job performance in adults with SCD include health-related (pain frequency and intensity, health-care utilization) and psychosocial (support system, coping mechanism). Moreover, poor academic achievement may increase the rates of unemployment in this patient group. The goal of this study is to compare patients’ rates of unemployment and disability with those of their unaffected siblings. Patients and Methods Twenty adult SCD patients (16 hemoglobin SS and 4 hemoglobin SC ; age: median = 29, range 20-56 years; sex: 8 males, 12 females) completed questionnaires relating to occupational experiences. Questionnaires were administered during routine clinic visits. Questions on the questionnaires relate to demographics, chronic pain scale, health-care utilization, use of hydroxyurea, employment status, length of employment, annual income, job satisfaction and use of tobacco, alcohol, or illicit drugs. These questionnaires also included questions relating to patients unaffected siblings who are within 5 years of age difference. We also performed paper and electronic chart review to obtain each patient’s health related data including number of days in the hospital for acute illnesses and for routine clinic appointments in the previous year, number of pain medications, other chronic medical conditions and SCD-related laboratory and tests results. Fourteen out of twenty patients (70%) were on hydroxyurea therapy and 14/20 (70%) had 3 or more hospitalizations in the previous one year. Patients on chronic transfusion therapy and those with other disabling conditions unrelated to SCD were excluded. Results Four out of twenty SCD patients (20%) are currently employed as compared to 15/20 (75%) of their healthy siblings (p < .001, all tests reported are Fisher’s Exact Test). Two of the SCD patients have been employed for more than 2 years as compared to 11 of their siblings (p = .006). Fourteen of SCD patients are on disability, while this is true for only one of the siblings (p < .001). Four of the twenty SCD patients are college graduates compared with 6 of the 20 unaffected siblings (p = .36). It is interesting to note that 12 out of 14 (86%) SCD patients who are currently on disability have previously had a job. Five of the fourteen (36%) SCD patients on disability reported that they missed more than 3 days per week of work due to their SCD. Of the unemployed patients, fourteen out of 16 (88%) wished they had a job. Conclusions This study highlights the negative impact of sickle cell disease on adult patients’ employment rates and job retention. Even though 16/20 (80%) of the SCD patients have previously had a job, only 20% are currently employed. Extension of this study will focus on development of specific interventions that may improve accommodation of SCD patients by encouraging collaboration between patients, families, medical providers, and employers. We believe that this is necessary in order to provide the most favorable environment for these patients to have better job functioning and it will also result in less economic burden on the society. Disclosures: No relevant conflicts of interest to declare.

Pain, Coping and Health Care Utilization in Younger and Older Adults with Sickle Cell Disease

2010 ◽  
Vol 15 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Kathryn A. Sanders ◽  
Susan M. Labott ◽  
Robert Molokie ◽  
Sarah R. Shelby ◽  
Joseph Desimone
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Care Utilization ◽  
Pain Coping ◽  
Cell Disease

scholarly journals Sickle-Cell Disease Co-Management, Health Care Utilization, and Hydroxyurea Use

2020 ◽  
Vol 33 (1) ◽  
pp. 91-105 ◽  
Author(s):  
Nancy Crego ◽  
Christian Douglas ◽  
Emily Bonnabeau ◽  
Marian Earls ◽  
Kern Eason ◽  
...  
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease

scholarly journals Evaluation of Longitudinal Pain Study in Sickle Cell Disease (ELIPSIS) by Electronic Patient-Reported Outcomes, Actigraphy, and Biomarkers

Blood ◽  
2020 ◽  
Author(s):  
Debra Pittman ◽  
Patrick C Hines ◽  
David Roger Beidler ◽  
Denis Rybin ◽  
Andrew L Frelinger ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Patient Reported Outcomes ◽  
Care Utilization ◽  
Cell Disease ◽  
Patient Reported ◽  
At Home

Clinical trials in sickle cell disease (SCD) often focus on health care utilization for painful vaso-occlusive crises (VOC). However, no objective, quantifiable pain biomarkers exist, pain is not specific to VOCs, health care utilization varies between patients, unreported at-home VOCs likely contribute to long-term outcomes, and patient-reported outcomes are seldom considered. This non-interventional, longitudinal, 6-month study aimed to develop tools to identify VOCs in SCD patients with or without health care utilization. Participants wore an actigraph device, tracking sleep and activity. SCD patients used an electronic patient-reported outcome (ePRO) tool collecting pain, medication, fatigue, and daily function. Patients self-reported when they experienced VOC pain (VOC day). Biomarkers were collected every 3 weeks (non-VOC). Self-reported VOCs triggered at-home or in-hospital blood collection. The study enrolled 37 participants with SCD; 35 completed the study. Participants reported 114 VOC events and 346 VOC days, of which 62.3% and 78.3%, respectively, were self-treated at home. The ePRO and actigraphy captured endpoints of pain, functionality, fatigue, activity, and sleep; each was significantly altered on VOC days compared with non-VOC days. Biomarkers collected at home or in hospital on VOC days were significantly altered compared with non-VOC baseline values, including leukocyte-platelet aggregates, microfluidic-based blood cell adhesion, interleukin-6, C-reactive protein, interleukin-10, tumor necrosis factor-alpha, and thrombin-antithrombin. ELIPSIS: demonstrates the feasibility of accurately monitoring out-of-hospital pain, using patient-reported VOC days as potential endpoints for clinical trials in SCD; showed changes in biomarkers and activity measured by actigraphy that may enable improved identification and assessment of VOCs.

scholarly journals Integration of Administrative Data and Chart Review for Reporting Health Care Utilization Among Children With Sickle Cell Disease

SAGE Open ◽  
2013 ◽  
Vol 3 (1) ◽  
pp. 215824401348247 ◽  
Author(s):  
Jean L. Raphael ◽  
Xuan G. Tran ◽  
Brigitta U. Mueller ◽  
Angelo P. Giardino
Keyword(s):  
Health Care ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Administrative Data ◽  
Sickle Cell ◽  
Chart Review ◽  
Care Utilization ◽  
Cell Disease
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