5 Findings From the November 2018 Issue of AJMC®

The November 2018 issue of The American Journal of Managed Care^® has a special focus on substance use disorder, but its studies also touch on disparities in patient portal adoption and the cost impacts of dementia. Here are 5 findings from the research published in the issue.

1. A pharmacist-led intervention can reduce opioid prescribing after orthopedic surgery

Investigators assessing the effects of a randomized intervention reported that the effort successfully lowered the amounts of opioids dispensed after hip replacement. The intervention consisted of 2 brochures mailed to patients before and after surgery that explained opioid use topics, as well as a follow-up telephone call from a pharmacist to check in on patients who filled an opioid prescription after surgery.

The researchers found a reduction in dispensed opioids among those who underwent hip replacement, but not knee replacement. They noted that this could be due to more severe and longer-lasting pain associated with knee arthroscopy and acknowledged that a more intensive intervention may be necessary to promote nonopioid pain treatment for these patients.

2. Relying on patient portal use can exacerbate racial and age-based disparities

As more and more primary care providers use patient portals to allow their clients to view, download, and transfer their health data, a study found disparities not only in who adopts this technology but also in which portal features are accessed. African American patients and those 70 years and older were significantly less likely to have accessed most of the portal functionalities, including interactive features like messaging and appointment management that are critical for care access.

Although patient portal technology can be a valuable tool for encouraging patient engagement, the authors cautioned that reliance on these portals alone could exacerbate current disparities. Instead, providers should adopt a multichannel approach to reach patients where they are and engage them in their care.

3. Costs of medication management for opioid use are modest, but may deter some patients

Recent evidence has supported the use of medication management to treat opioid use disorder (OUD) post detoxification, but a new cost analysis is among the first to estimate the costs of introducing pharmacotherapy at 8 treatment sites nationwide. Researchers found that extended-release naltrexone had higher mean intervention costs per patient than buprenorphine-naloxone ($5416 vs 4148), driven by higher medication costs for the former that outweighed the financial effect of less frequent visits needed with that treatment option.

The study’s thorough examination of costs included calculations of the expenses incurred by patients to travel to the treatment facility as well as wage values of patients’ and care providers’ time. The authors hoped that this practical information will help stakeholders weigh the costs and benefits associated with expanding access to empirical treatment for OUD, especially for patients who may experience barriers to treatment due to cost.

4. Alzheimer and other dementias increase costs and prevalence of certain comorbidities

Numerous studies have described the high financial and personal tolls of Alzheimer disease and other dementias (ADOD); now, an analysis compares the prevalence and costs of 15 comorbid conditions in over 1 million Medicare beneficiaries with and without ADOD. The 9.4% of the population who had ADOD accounted for 22.8% of the total costs, and the comorbidities were more prevalent and costly per person in this group compared with the group without ADOD.

The investigators explained how their findings may indicate some important areas of focus for population health management, most notably fractures, urinary tract infections, and diabetes without complications. They concluded that cost-effective management of ADOD must include not only treatment of dementia symptoms but also prevention and effective treatment of costly comorbid conditions.

5. Overdose risk increases for veterans receiving opioids from multiple pharmacy systems

When veterans fill prescriptions at both Veterans Health Administration (VHA) and non-VHA pharmacies, are they more likely to overdose than those who stuck with VHA pharmacies only? A new cohort study suggests that dual care use was associated with higher odds of nonfatal opioid overdose and all-cause mortality. Dual care users were also more likely to live in rural areas and have concurrent prescriptions of opioids and benzodiazepines.

According to the authors, the results highlight the importance of coordinating care and therapy across sites, potentially through the use of prescription monitoring programs that share data between VHA and other sites. Their findings are especially timely as veterans gain more access to non-VHA care and providers through the Veterans Choice program.