Medical Care
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The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013
Importance:
It is important to understand the magnitude and distribution of the economic burden of prescription opioid overdose, abuse, and dependence to inform clinical practice, research, and other decision makers. Decision makers choosing approaches to address this epidemic need cost information to evaluate the cost effectiveness of their choices.
Objective:
To estimate the economic burden of prescription opioid overdose, abuse, and dependence from a societal perspective.
Design, Setting, and Participants:
Incidence of fatal prescription opioid overdose from the National Vital Statistics System, prevalence of abuse and dependence from the National Survey of Drug Use and Health. Fatal data are for the US population, nonfatal data are a nationally representative sample of the US civilian noninstitutionalized population ages 12 and older. Cost data are from various sources including health care claims data from the Truven Health MarketScan Research Databases, and cost of fatal cases from the WISQARS (Web-based Injury Statistics Query and Reporting System) cost module. Criminal justice costs were derived from the Justice Expenditure and Employment Extracts published by the Department of Justice. Estimates of lost productivity were based on a previously published study.
Exposure:
Calendar year 2013.
Main Outcomes and Measures:
Monetized burden of fatal overdose and abuse and dependence of prescription opioids.
Results:
The total economic burden is estimated to be $78.5 billion. Over one third of this amount is due to increased health care and substance abuse treatment costs ($28.9 billion). Approximately one quarter of the cost is borne by the public sector in health care, substance abuse treatment, and criminal justice costs.
Conclusions and Relevance:
These estimates can assist decision makers in understanding the magnitude of adverse health outcomes associated with prescription opioid use such as overdose, abuse, and dependence.
Medical Care - Tập 54 Số 10 - Trang 901-906 - 2016
Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population
Medical Care - Tập 46 Số 3 - Trang 266-274 - 2008
Novel Health Information Technology to Aid Provider Recognition and Treatment of Major Depressive Disorder and Posttraumatic Stress Disorder in Primary Care
Background:
Millions of traumatized refugees worldwide have resettled in the United States. For one of the largest, the Cambodian community, having their mental health needs met has been a continuing challenge. A multicomponent health information technology screening tool was designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting.
Methods:
In a clustered randomized controlled trial, 18 primary care providers were randomized to receive access to a multicomponent health information technology mental health screening intervention, or to a minimal intervention control group; 390 Cambodian American patients empaneled to participating providers were assigned to the providers’ randomized group.
Results:
Electronic screening revealed that 65% of patients screened positive for depression and 34% screened positive for PTSD. Multilevel mixed effects logistic models, accounting for clustering structure, indicated that providers in the intervention were more likely to diagnose depression [odds ratio (OR), 6.5; 95% confidence interval (CI), 1.48–28.79; P =0.013] and PTSD (OR, 23.3; 95% CI, 2.99–151.62; P =0.002) among those diagnosed during screening, relative to the control group. Providers in the intervention were more likely to provide evidence-based guideline (OR, 4.02; 95% CI, 1.01–16.06; P =0.049) and trauma-informed (OR, 15.8; 95% CI, 3.47–71.6; P <0.001) care in unadjusted models, relative to the control group. Guideline care, but not trauma-informed care, was associated with decreased depression at 12 weeks in both study groups (P =0.003), and neither was associated with PTSD outcomes at 12 weeks.
Conclusions:
This innovative approach offers the potential for training primary care providers to diagnose and treat traumatized patients, the majority of whom seek mental health care in primary care (ClinicalTrials.gov number, NCT03191929).
Medical Care - Tập 57 Số Suppl 2 - Trang S190-S196 - 2019
Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization
Medical Care - Tập 37 Số 1 - Trang 5-14 - 1999
Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care
Background:
Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption.
Objectives:
To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer’s perspective.
Research Design:
Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program’s expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources.
Results:
CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4–5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure—approximately 3%–4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings.
Conclusion:
Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient’s primary diagnosis.
Medical Care - Tập 55 Số 2 - Trang 140-147 - 2017
Development and Validation of an Index to Predict Activity of Daily Living Dependence in Community-Dwelling Elders
Medical Care - Tập 44 Số 2 - Trang 149-157 - 2006
Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC)
Medical Care - Tập 43 Số 5 - Trang 436-444 - 2005
Disparities in Mammography Use Among US Women Aged 40–64 Years, by Race, Ethnicity, Income, and Health Insurance Status, 1993 and 2005
Medical Care - Tập 46 Số 7 - Trang 692-700 - 2008
One Thousand Health-Related Quality-of-Life Estimates
Medical Care - Tập 38 Số 6 - Trang 583-637 - 2000
Heterogeneity in the Quality of Care for Patients With Multiple Chronic Conditions by Psychiatric Comorbidity
Medical Care - Tập 52 Số Supplement 2 - Trang S101-S109 - 2014
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