Explore the vast range of titles available.

Improving medication adherence across the health care system is an ingredient that is vital to improving patient outcomes and reducing downstream health care costs. The Pennsylvania Project, a large-scale community pharmacy demonstration study, evaluated the impact of a pharmacy-based intervention on adherence to five chronic medication classes. To implement the study, 283 pharmacists from a national community pharmacy chain were assigned to the intervention group. Collectively, they screened 29,042 patients for poor adherence risk and provided brief interventions to people with an elevated risk. Compared to a control group of 295 pharmacists who screened 30,454 patients, the intervention significantly improved adherence for all medication classes, from 4.8 percent for oral diabetes medications to 3.1 percent for betablockers. Additionally, there was a significant reduction in per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). This study demonstrated that pharmacist-provided intervention is a cost-effective tool that may be applied in community pharmacies and health care sites across the country.

BackgroundThe World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials.ObjectiveThe current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment.Design and ParticipantsSecondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806).MeasuresAlcohol use was measured via calendar-based methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment.Key ResultsOne-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking.ConclusionAUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning.

This cross-sectional study examines the association of law enforcement seizures of heroin, fentanyl, and carfentanil with opioid overdose deaths in Ohio from 2014 to 2017.

Background Medications to treat opioid use disorder (OUD) including buprenorphine products are evidence-based and cost-effective tools for combating the opioid crisis. However, limited availability to buprenorphine is pervasive in the United States (US) and may serve to exacerbate the deadly epidemic. Although prior research points to rural counties as especially needy of strategies that improve buprenorphine availability, it is important to investigate the availability of waivered providers according to treatment need as defined by the county-level rate of opioid-overdose deaths (OOD). This study examined differences in buprenorphine provider availability relative to treatment need among rural and urban counties in the US. Methods Buprenorphine provider availability relative to need in each county was defined as the number of waivered providers divided by the rate of OODs (i.e., number of OODs/100,000 population), according to 2018 data. Counties with ratios in the bottom tertile of their state were classified as buprenorphine undersupplied. We estimated logit models to statistically test the association of rurality and state main effects and their interaction terms (independent variables) and the county classified as buprenorphine undersupplied (dependent variable). Results A total of 38 states and 2595 counties had sufficient non-suppressed data to remain in the analysis. A larger percent of urban counties (36.43%) than rural counties (32.01%) were classified as buprenorphine undersupplied (p  = 0.001). The likelihood of a rural county being undersupplied varied considerably by state (Chi Square  = 82.88, p  = 0.000). All states with significant (p  < 0.05 or p  < 0.10) interaction terms showed lower likelihood of buprenorphine undersupply in rural counties. Conclusions The rural–urban distribution in undersupply of waivered buprenorphine providers relative to need varied markedly by state. Strategies for improving access to buprenorphine-waivered providers should be state-centric and informed by county-specific indicators of need.

Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (P=.01 and P<.001, respectively), as well as in the following year (P=.03 and P=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (P=.03). Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin.

Background Communities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility. Methods This study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars. Results State-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost. Conclusion We identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

OBJECTIVE:This innovative study examines for the first time the relationship between occupational factors (eg, job strain) and medication adherence. METHODS:An analysis of secondary data collected from a randomized controlled trial (RCT) implemented in 34 drugstores of a national pharmacy chain in Tennessee. Medication adherence, health care utilization, psychosocial assessment, chronic disease status, and occupational health history data were obtained from study participants. RESULTS:The study found that most job strains are less adherent to their medication regimen as measured by proportion of days covered (PDC) than those in a low strain job category. However, statistically significant differences are observed only for renin angiotensin system antagonists (RASA), statins, and when PDC is combined across all medication classes. CONCLUSIONS:Examining occupational factors may prove beneficial in developing interventions that improve medication adherence.

Background : The diversion of prescription stimulants for misuse, particularly those used in the treatment of attention-deficit hyperactivity disorder (ADHD), is potentially a significant problem for public health and for healthcare funding and delivery. Most prior research on the diversion of prescription stimulants for misuse, particularly those used in the treatment of ADHD, has focused on the ‘end users’ of diverted medications rather than the suppliers. Furthermore, little is known about the direct costs of diversion for third-party insurance payers in the US. Objectives : The objectives of this study were to estimate the prevalence in the US of people whose private insurance paid costs for ADHD prescriptions that they gave or sold to another person (diversion), and to estimate medication costs of diversion to private insurers. Methods : Estimates are from a cross-sectional survey of respondents from two Internet survey panels targeting individuals aged 18–49 years in the civilian, noninstitutionalized US population, principally for those who filled prescriptions for ADHD medications in the past 30 days that were covered by private health insurance. Analysis weights were post-stratified to control totals from the Current Population Survey and National Health Interview Survey. Weighted prevalence rates and standard errors for diversion are reported, as are the costs of diverted pills using drug prices reported in the 2008 Thomson Reuters RED BOOK ™. Sensitivity analyses were conducted that varied the cost assumptions for medications. Results : Among individuals aged 18–49 years whose private insurance paid some costs for ADHD medications in the past 30 days, 16.6% diverted medications from these prescriptions. Men aged 18–49 years for whom private insurance paid some costs of ADHD drugs in the past 30 days were more than twice as likely as their female counterparts to divert medications from these prescriptions (22.5% vs 9.1%; p= 0.03). After a pro-rated co-payment share was subtracted, the estimated value of diverted medications in a 30-day period was $US8.0 million. Lower- and upper-bound estimates were $US6.9 million to $US17 million, for a range of $US83 million to $US204 million annually. Overall, diversion accounted for about 3.6% of the total costs that private insurers paid for ADHD medications (range: 3.5–4.5%). The percentages varied by medication category, although relative differences were sensitive to inclusion of a pro-rated co-payment. A higher percentage of the costs of extended-release (XR) medications was lost to diversion compared with that for immediate-release (IR) medications. Conclusions : Costs of ADHD medications paid for by private insurers that were lost to diversion were small relative to the total estimated medication costs and relative to total estimated healthcare costs for treating ADHD. Nevertheless, there may be significant cost savings for insurers if diversion can be reduced, particularly for XR medications. These findings represent a first step to informing policies to reduce diversion both in the interest of public health and for direct and indirect cost savings to insurers.

Opioid use disorder (OUD) remains a critical public health crisis across the United States. To address this challenge, the HEALing Measurement Center, funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, aims to enhance the quality, equity, and sustainment of care delivered in Pennsylvania opioid treatment programs (OTPs) through the implementation of measurement-based care (MBC). This initiative leverages interdisciplinary collaboration among academic researchers, state and community partners, payers, and OTP providers to address critical gaps in OUD treatment and implementation science.BACKGROUNDOpioid use disorder (OUD) remains a critical public health crisis across the United States. To address this challenge, the HEALing Measurement Center, funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative, aims to enhance the quality, equity, and sustainment of care delivered in Pennsylvania opioid treatment programs (OTPs) through the implementation of measurement-based care (MBC). This initiative leverages interdisciplinary collaboration among academic researchers, state and community partners, payers, and OTP providers to address critical gaps in OUD treatment and implementation science.Three research projects were designed to address immediate implementation support needs expressed by community partners while simultaneously meeting critical research gaps. Research Project 1 develops an MBC implementation blueprint co-designed with key constituents to address barriers such as paperwork burden and facilitate technical assistance and learning networks. Research Project 2 evaluates the effectiveness and implementation of an enhanced MBC implementation strategy (MBC +) compared to measurement implementation as usual (MAU) through a hybrid type 2 stepped-wedge effectiveness-implementation trial. Research Project 3 focuses on the clinical impact of MBC + on patients with OUD and co-occurring mental health conditions, exploring mechanisms underlying treatment success.METHODSThree research projects were designed to address immediate implementation support needs expressed by community partners while simultaneously meeting critical research gaps. Research Project 1 develops an MBC implementation blueprint co-designed with key constituents to address barriers such as paperwork burden and facilitate technical assistance and learning networks. Research Project 2 evaluates the effectiveness and implementation of an enhanced MBC implementation strategy (MBC +) compared to measurement implementation as usual (MAU) through a hybrid type 2 stepped-wedge effectiveness-implementation trial. Research Project 3 focuses on the clinical impact of MBC + on patients with OUD and co-occurring mental health conditions, exploring mechanisms underlying treatment success.This protocol provides an overview of the research design as well as the unique community partnerships leveraged to enhance MBC implementation. Overall, the projects within the HEALing Measurement Center aim to establish a foundation for future MBC scale-up and sustainment across Pennsylvania, provide learnings that can inform other implementation efforts, and enhance the quality of interventions for individuals with OUD.DISCUSSIONThis protocol provides an overview of the research design as well as the unique community partnerships leveraged to enhance MBC implementation. Overall, the projects within the HEALing Measurement Center aim to establish a foundation for future MBC scale-up and sustainment across Pennsylvania, provide learnings that can inform other implementation efforts, and enhance the quality of interventions for individuals with OUD.Clinicaltrials.gov, NCT06965010, Registered 11 May 2025, https://clinicaltrials.gov/study/NCT06965010.TRIAL REGISTRATIONClinicaltrials.gov, NCT06965010, Registered 11 May 2025, https://clinicaltrials.gov/study/NCT06965010.

This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Service-level data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models.