المؤلفون: Adam J. Rose, Guneet K. Jasuja, Thomas Byrne, Dana Bernson, Amy Bettano, Megan B. McCullough, David A. Smelson, Dan R. Berlowitz, Donald R. Miller

المصدر: Medical Care. 59:S165-S169

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Databases, Factual, Population, Odds, Young Adult, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Health care, medicine, Humans, 030212 general & internal medicine, Psychiatry, education, health care economics and organizations, Veterans, education.field_of_study, business.industry, 030503 health policy & services, Public health, Public Health, Environmental and Occupational Health, Opioid overdose, Middle Aged, Opioid-Related Disorders, medicine.disease, United States, humanities, Opiate Overdose, United States Department of Veterans Affairs, Cross-Sectional Studies, Massachusetts, Opioid, Ill-Housed Persons, Female, 0305 other medical science, business, medicine.drug

الوصف: BACKGROUND Compared with non-Veterans, Veterans are at higher risk of experiencing homelessness, which is associated with opioid overdose. OBJECTIVE To understand how homelessness and Veteran status are related to risks of nonfatal and fatal opioid overdose in Massachusetts. DESIGN A cross-sectional study. PARTICIPANTS All residents aged 18 years and older during 2011-2015 in the Massachusetts Department of Public Health's Data Warehouse (Veterans: n=144,263; non-Veterans: n=6,112,340). A total of 40,036 individuals had a record of homelessness, including 1307 Veterans and 38,729 non-Veterans. MAIN MEASURES The main independent variables were homelessness and Veteran status. Outcomes included nonfatal and fatal opioid overdose. RESULTS A higher proportion of Veterans with a record of homelessness were older than 45 years (77% vs. 48%), male (80% vs. 62%), or receiving high-dose opioid therapy (23% vs. 15%) compared with non-Veterans. The rates of nonfatal and fatal opioid overdose in Massachusetts were 85 and 16 per 100,000 residents, respectively. Among individuals with a record of homelessness, these rates increased 31-fold to 2609 and 19-fold to 300 per 100,000 residents. Homelessness and Veteran status were independently associated with higher odds of nonfatal and fatal opioid overdose. There was a significant interaction between homelessness and Veteran status in their effects on risk of fatal overdose. CONCLUSIONS Both homelessness and Veteran status were associated with a higher risk of fatal opioid overdoses. An understanding of health care utilization patterns can help identify treatment access points to improve patient safety among vulnerable individuals both in the Veteran population and among those experiencing homelessness.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c5a8a44674e265a55a6673202440f1f5Test
https://doi.org/10.1097/mlr.0000000000001437Test

المؤلفون: Adam J. Rose, Harry H Liu, Annie Y Chen, Kanaka Shetty

المصدر: Journal of managed carespecialty pharmacy. 27(5)

مصطلحات موضوعية: Polypharmacy, Aged, 80 and over, Male, medicine.medical_specialty, Databases, Factual, business.industry, Medication Therapy Management, Health Policy, Pharmaceutical Science, Management model, Pharmacy, Middle Aged, Patient Acceptance of Health Care, Drug Costs, United States, Medication Adherence, Medication care, Family medicine, Health care, Medicine, Humans, Female, business, Aged, Program Evaluation

الوصف: BACKGROUND: Multimorbidity and polypharmacy are common in the United States and are associated with greater risk of disease-related complications and higher health care costs. ExactCare has impleme...

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3f8e3ab66a9750f231bc35e89004213eTest
https://pubmed.ncbi.nlm.nih.gov/33560167Test

المؤلفون: Hill L Wolfe, Alexander de Groot, Jaclyn M. White Hughto, Carl G. Streed, Michael K. Paasche-Orlow, Michael Stephen Dunbar, Omid Ameli, Adam J. Rose, Madeline B. Deutsch, Emily Quinn, Guneet K. Jasuja

المصدر: Med Care

مصطلحات موضوعية: Research design, Adult, Data Analysis, Male, Gender Identity Disorder, Databases, Factual, Population, Medicare Advantage, computer.software_genre, Endocrine System Diseases, Medicare, Transgender Persons, Article, 03 medical and health sciences, 0302 clinical medicine, Transgender, Humans, 030212 general & internal medicine, education, Gender Dysphoria, Aged, Retrospective Studies, education.field_of_study, Database, 030503 health policy & services, Procedure code, Not Otherwise Specified, Public Health, Environmental and Occupational Health, Middle Aged, United States, Cohort, Female, 0305 other medical science, Psychology, computer, Gonadal Hormones

الوصف: Background Large administrative databases often do not capture gender identity data, limiting researchers' ability to identify transgender people and complicating the study of this population. Objective The objective of this study was to develop methods for identifying transgender people in a large, national dataset for insured adults. Research design This was a retrospective analysis of administrative claims data. After using gender identity disorder (GID) diagnoses codes, the current method for identifying transgender people in administrative data, we used the following 2 strategies to improve the accuracy of identifying transgender people that involved: (1) Endocrine Disorder Not Otherwise Specified (Endo NOS) codes and a transgender-related procedure code; or (2) Receipt of sex hormones not associated with the sex recorded in the patient's chart (sex-discordant hormone therapy) and an Endo NOS code or transgender-related procedure code. Subjects Seventy-four million adults 18 years and above enrolled at some point in commercial or Medicare Advantage plans from 2006 through 2017. Results We identified 27,227 unique transgender people overall; 18,785 (69%) were identified using GID codes alone. Using Endo NOS with a transgender-related procedure code, and sex-discordant hormone therapy with either Endo NOS or transgender-related procedure code, we added 4391 (16%) and 4051 (15%) transgender people, respectively. Of the 27,227 transgender people in our cohort, 8694 (32%) were transmasculine, 3959 (15%) were transfeminine, and 14,574 (54%) could not be classified. Conclusion In the absence of gender identity data, additional data elements beyond GID codes improves the identification of transgender people in large, administrative claims databases.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::288f3135133b21463b2fac14a584da0bTest
https://europepmc.org/articles/PMC8010422Test/

المؤلفون: Adam J. Rose, Dan R. Berlowitz, Joel I. Reisman, Guneet K. Jasuja, Omid Ameli, Donald R. Miller, Shalender Bhasin

المصدر: JAMA Network Open

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Anemia, Veterans Health, Endocrine System Diseases, law.invention, Randomized controlled trial, law, Internal medicine, Cause of Death, Androgen deficiency, medicine, Humans, Testosterone, Medical prescription, Original Investigation, Aged, Aged, 80 and over, business.industry, Research, Incidence, Testosterone (patch), General Medicine, Middle Aged, medicine.disease, Opioid-Related Disorders, United States, Online Only, Diabetes and Endocrinology, Treatment Outcome, Opioid, Cardiovascular Diseases, Androgens, Spinal Fractures, business, Femoral Fractures, Mace, medicine.drug, Cohort study, Follow-Up Studies

الوصف: This cohort study analyzes the association between testosterone and opioid use and improved health outcomes among male US military veterans with opioid-induced androgen deficiency.
Key Points Question What are the health outcomes among long-term opioid users who receive testosterone treatment compared with opioid users who do not? Findings In this cohort study of 21 272 male long-term opioid users with testosterone deficiency, those who received opioids plus testosterone therapy had significantly lower all-cause mortality and lower incidence of major adverse cardiovascular events, anemia, and femoral or hip fractures than their counterparts who received opioids only in covariate-adjusted and propensity score–matched models. Meaning This study’s findings suggest that receiving opioids plus testosterone treatment is associated with lower all-cause mortality and a lower incidence of other adverse health outcomes among men with opioid-induced androgen deficiency.
Importance Androgen deficiency is common among male opioid users, and opioid use has emerged as a common antecedent of testosterone treatment. The long-term health outcomes associated with testosterone therapy remain unknown, however. Objective To compare health outcomes between long-term opioid users with testosterone deficiency who filled testosterone prescriptions and those with the same condition but who did not receive testosterone treatment. Design, Setting, and Participants This cohort study focused on men in the care of the Veterans Health Administration (VHA) facilities throughout the United States from October 1, 2008, to September 30, 2014. It included male veterans who were long-term opioid users, had low testosterone levels (

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bedbbaa57694f557a359374428255117Test
http://europepmc.org/articles/PMC6991198Test

المؤلفون: Alok Kapoor, Weisong Liu, Robert J. Goldberg, Victoria Wang, David D. McManus, Hong Yu, Adam J. Rose

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.drug_class, Non valvular atrial fibrillation, Administration, Oral, 030204 cardiovascular system & hematology, Drug Prescriptions, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Atrial Fibrillation, medicine, Humans, veterans, 030212 general & internal medicine, Practice Patterns, Physicians', anticoagulation, Aged, Original Research, Aged, 80 and over, business.industry, Anticoagulant, Anticoagulants, Atrial fibrillation, Middle Aged, Health Services, medicine.disease, Veterans health, Drug Utilization, United States, 3. Good health, United States Department of Veterans Affairs, Treatment Outcome, Stroke prevention, Veterans Health Services, Cardiology, Female, Warfarin, stroke prevention, Cardiology and Cardiovascular Medicine, business, Direct acting, Factor Xa Inhibitors, Health Services and Outcomes Research, practice variation

الوصف: Background Direct acting oral anticoagulants ( DOAC s) theoretically could contribute to addressing underuse of anticoagulation in non‐valvular atrial fibrillation ( NVAF ). Few studies have examined this prospect, however. The potential of DOAC s to address underuse of anticoagulation in NVAF could be magnified within a healthcare system that sharply limits patients’ exposure to out‐of‐pocket copayments, such as the Veterans Health Administration ( VA ). Methods and Results We used a clinical data set of all patients with NVAF treated within VA from 2007 to 2016 (n=987 373). We examined how the proportion of patients receiving any anticoagulation, and which agent was prescribed, changed over time. When first approved for VA use in 2011, DOAC s constituted a tiny proportion of all prescriptions for anticoagulants (2%); by 2016, this proportion had increased to 45% of all prescriptions and 67% of new prescriptions. Patient characteristics associated with receiving a DOAC , rather than warfarin, included white race, better kidney function, fewer comorbid conditions overall, and no history of stroke or bleeding. In 2007, before the introduction of DOAC s, 56% of VA patients with NVAF were receiving anticoagulation; this dipped to 44% in 2012 just after the introduction of DOAC s and had risen back to 51% by 2016. Conclusions These results do not suggest that the availability of DOAC s has led to an increased proportion of patients with NVAF receiving anticoagulation, even in the context of a healthcare system that sharply limits patients’ exposure to out‐of‐pocket copayments.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0d4575227a44c17536ed919a473eb7dcTest
https://doi.org/10.1161/jaha.119.012646Test

المؤلفون: Taekyu Kim, Amresh D. Hanchate, Adam J. Rose, Michael K. Paasche-Orlow, Eun Ji Kim

المصدر: Journal of General Internal Medicine. 32:632-639

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Pediatrics, education, Language barrier, 030204 cardiovascular system & hematology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, Humans, Medicine, 030212 general & internal medicine, Healthcare Disparities, health care economics and organizations, Language, Retrospective Studies, business.industry, Communication Barriers, Capsule Commentary, Middle Aged, Health Surveys, Logistic Models, Population Surveillance, Family medicine, Limited English proficiency, Hypertension, Female, business, hormones, hormone substitutes, and hormone antagonists

الوصف: Limited English proficiency (LEP) is associated with poor health status and worse outcomes.To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency.Retrospective analysis of multi-year survey data.Adults 18 years of age and older who participated in the NHANES survey during the period 2003-2012.We defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) 140 mmHg or diastolic blood pressure (DBP) 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables.Fourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30-33.12]).In a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::59e318e9ca1bdd4ffa3809c0af618a94Test
https://doi.org/10.1007/s11606-017-3999-9Test

المؤلفون: Adam J. Rose, Joel I. Reisman, Daniel B. Ambrus

المصدر: Thrombosis Research. 144:21-26

مصطلحات موضوعية: Male, medicine.medical_specialty, Warfarin therapy, Hemorrhage, Newly diagnosed, 030204 cardiovascular system & hematology, New onset, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Neoplasms, Internal medicine, Atrial Fibrillation, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Aged, Veterans, Aged, 80 and over, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, Venous Thromboembolism, Hematology, Middle Aged, medicine.disease, Treatment Outcome, Cardiology, Female, business, Venous thromboembolism, Major bleeding, medicine.drug, Cohort study

الوصف: Background A new cancer diagnosis adds significant complexity and uncertainty to the management of pre-existing warfarin therapy. Objectives To determine how new-onset cancer affects anticoagulation control and outcomes among patients who had been receiving warfarin for atrial fibrillation (AF) compared to patients who had been receiving warfarin for venous thromboembolism (VTE) prior to cancer diagnosis. Patients/methods This cohort study started with 122,875 veterans who had been receiving warfarin for at least six months from a VA Medical Center between 10/1/06 and 9/30/08. We identified patients with incident cancer during this interval, and excluded those with a prior cancer history. We analyzed percent time in therapeutic range (TTR) at 6 and 12-month intervals after cancer diagnosis compared to pre-cancer baseline, as well as crude rates of warfarin-relevant outcomes (stroke, major bleeding, mortality) between patients with AF and VTE. Results Among patients with new-onset cancer, patients anticoagulated for AF outnumbered those anticoagulated for VTE more than 2.5-fold. There were no significant differences in TTR by indication for warfarin in months 0–6 or 7–12 following cancer diagnosis, but TTR decreased significantly compared to the pre-cancer baseline for both groups in months 0–6. As expected, cancer patients with VTE had significantly worse mortality at six months and one year compared to cancer patients with AF. Conclusion Patients receiving chronic warfarin therapy who are newly diagnosed with cancer experience a significant decrease in TTR in the first 6 months after diagnosis, regardless of indication for anticoagulation. This effect appears to attenuate in months 7–12.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ab34b5c0bd3bb677399d15d2f27059a2Test
https://doi.org/10.1016Test/j.thromres.2016.05.028

المؤلفون: Guneet K, Jasuja, Joel I, Reisman, Renda Soylemez, Weiner, Melissa L, Christopher, Adam J, Rose

المصدر: The American journal of managed care. 25(3)

مصطلحات موضوعية: Adult, Aged, 80 and over, Male, Dose-Response Relationship, Drug, Age Factors, Inappropriate Prescribing, Interrupted Time Series Analysis, Middle Aged, Drug Utilization, United States, Zolpidem, Benzodiazepines, United States Department of Veterans Affairs, Young Adult, Cross-Sectional Studies, Logistic Models, Sex Factors, Socioeconomic Factors, Humans, Hypnotics and Sedatives, Female, Practice Patterns, Physicians', Aged

الوصف: Use of nonbenzodiazepine sedative hypnotics, especially zolpidem, has grown substantially, raising concerns about safety. Here, we evaluated prescribing patterns of zolpidem in the Veterans Health Administration.A cross-sectional study of veterans receiving zolpidem in the outpatient setting from October 1, 2011, to September 30, 2016.The study population consisted of 500,332 zolpidem users (58,598 women and 441,734 men) and a random 10% sample (n = 631,449) of nonusers. We examined 2 outcomes related to inappropriate prescribing: high-dose zolpidem prescribing and overlap with benzodiazepines. We generated interrupted time series and logistic regression models to analyze these outcomes in men and women separately.In 2016, 29.7% of female veterans received an inappropriately high guideline-discordant dosage compared with 0.1% of male veterans (P.001 for all reported comparisons). Furthermore, more women than men had overlapping benzodiazepine and zolpidem prescriptions (18.8% vs 14.3%). In fully adjusted models, inappropriately high doses were more commonly received by younger women (adjusted odds ratios [AORs]: 2.75 for 21-39 years and 2.97 for 40-49 years compared with ≥80 years) and women with substance use disorder (AOR, 1.48). In the second inappropriateness outcome models, women with anxiety (AOR, 2.28) or schizophrenia (AOR, 2.05) and men with cancer (AOR, 1.42), anxiety (AOR, 2.66), or schizophrenia (AOR, 2.46) were more likely to receive an overlapping prescription of zolpidem and benzodiazepines.We found evidence of inappropriate zolpidem prescribing among veterans, particularly women. Greater understanding of the drivers of this inappropriate prescribing is necessary to develop interventions to promote safer, more guideline-concordant prescribing.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::6bb6646cb43a9ecad463e4964d7afcc0Test
https://pubmed.ncbi.nlm.nih.gov/30875172Test

المؤلفون: Ryan Bernstein, Adam J. Rose, Monica Bharel, Marc R. Larochelle, Thomas J. Stopka, Alexander Y. Walley, Dana Bernson, Jane M. Liebschutz, Thomas Land

المصدر: Drug Alcohol Depend

مصطلحات موضوعية: Adult, Male, Risk, medicine.medical_specialty, Adolescent, Population, Toxicology, Drug Prescriptions, Article, Young Adult, Criminal Law, medicine, Humans, Pharmacology (medical), education, Child, Retrospective Studies, Pharmacology, education.field_of_study, business.industry, Retrospective cohort study, Opioid overdose, Middle Aged, Patient Acceptance of Health Care, medicine.disease, Opioid-Related Disorders, Analgesics, Opioid, Psychiatry and Mental health, Standardized mortality ratio, Opioid, Massachusetts, Relative risk, Emergency medicine, Cohort, Female, Drug Overdose, business, medicine.drug, Cohort study, Forecasting

الوصف: Background Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown. Methods We used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, we identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The outcome was opioid overdose death. We calculated Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) associated with touchpoint exposure. Results The cohort consisted of 6,717,390 person-years of follow-up with 1315 opioid overdose deaths. We identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose SMRs were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose PAFs were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints. Conclusions Using public health data, we found eight candidate touchpoints were associated with increased risk of fatal opioid overdose, and collectively identified more than half of opioid overdose decedents. These touchpoints are potential targets for development of overdose prevention interventions.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2b2019397fc975ae46dd476bacaeb159Test
https://pubmed.ncbi.nlm.nih.gov/31521956Test

المؤلفون: Guneet K, Jasuja, Omid, Ameli, Donald R, Miller, Thomas, Land, Dana, Bernson, Adam J, Rose, Dan R, Berlowitz, David A, Smelson

المصدر: The American journal of managed care. 24(11)

مصطلحات موضوعية: Adult, Aged, 80 and over, Male, Pharmacies, Mental Disorders, Age Factors, Comorbidity, Middle Aged, Opioid-Related Disorders, United States, Analgesics, Opioid, Benzodiazepines, United States Department of Veterans Affairs, Mental Health, Sex Factors, Massachusetts, Socioeconomic Factors, Residence Characteristics, Humans, Female, Drug Overdose, Aged, Veterans

الوصف: The aim of this study was to evaluate whether veterans in Massachusetts receiving opioids and/or benzodiazepines from both Veterans Health Administration (VHA) and non-VHA pharmacies are at higher risk of adverse events compared with those receiving opioids at VHA pharmacies only.A cohort study of veterans who filled a prescription for any Schedule II through V substance at a Massachusetts VHA pharmacy. Prescriptions were recorded in the Massachusetts Department of Public Health Chapter 55 data set.The study sample included 16,866 veterans residing in Massachusetts, of whom 9238 (54.8%) received controlled substances from VHA pharmacies only and 7628 (45.2%) had filled prescriptions at both VHA and non-VHA pharmacies ("dual care users") between October 1, 2013, and December 31, 2015. Our primary outcomes were nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.Compared with VHA-only users, more dual care users resided in rural areas (12.6% vs 10.6%), received high-dose opioid therapy (26.3% vs 7.3%), had concurrent prescriptions of opioids and benzodiazepines (34.8% vs 8.2%), and had opioid use disorder (6.8% vs 1.6%) (P.0001 for all). In adjusted models, dual care users had higher odds of nonfatal opioid overdose (odds ratio [OR], 1.29; 95% CI, 0.98-1.71) and all-cause mortality (OR, 1.66; 95% CI, 1.43-1.93) compared with VHA-only users. Dual care use was not associated with fatal opioid overdoses.Among veterans in Massachusetts, receipt of opioids from multiple sources was associated with worse outcomes, specifically nonfatal opioid overdose and mortality. Better information sharing between VHA and non-VHA pharmacies and prescribers has the potential to improve patient safety.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::e85f0adf4aa66e8b3333a2b0b583d0a9Test
https://pubmed.ncbi.nlm.nih.gov/30452210Test