The Open Public Health Journal




ISSN: 1874-9445 ― Volume 13, 2020
RESEARCH ARTICLE

Impact of a Health System's Three-Pronged Strategy to Address the Opioid Epidemic in DE, PA, and WV, 2013-2017



Charles DeShazer1, Oralia Dominic1, *, Caesar DeLeo1, Rhonda Johnson1
1 Health Plan Chief Medical Officer (CMO) Organization, Highmark Inc., Pittsburgh, PA, USA

Abstract

Background:

In the past two decades, from 1999-2017, more than 700,000 people have died from a drug overdose in the United States. In 2017, more than 68% of the drug overdose deaths involved an opioid, and the opioid death rate was six times higher than in 1999. Although treatable, opioid addiction has significant health consequences; and evidence-based, data-driven models addressing these opioid-related factors remain sparse.

Objectives:

To help stem this epidemic, Highmark Inc., a national health plan as well as the second largest integrated delivery and financing system in America, developed, implemented and evaluated a series of quality management-focused opioid interventions utilizing a three-pronged public health approach. We focused on more effectively managing pain to reduce the need for opioids (primary prevention); when needed, prescribing opioids according to safe prescribing guidelines (secondary prevention); and for those with Opioid Use Disorder (OUD), ensuring access to effective treatment to reduce morbidity/mortality (tertiary prevention) for our members.

Methods:

We deployed a series of evidence-based and data-driven interventions utilizing clinical guidelines, integrated and coordinated infrastructures, and community-based participatory research frameworks within our service areas of Delaware, Pennsylvania, and West Virginia. We examined medical and pharmacy claims for combined data years 2013-2017 by age, product (commercial, diagnosis with OUD), total Opioid prescription (RX) fill rate (per 1,000 members), opioid use by dose (dosage level by Morphine Milligram Equivalents), opioid use by duration (number days of opioid use), rate per 1,000 members diagnosed with OUD, and geography.

Results:

Improvements in total Opioid RX fills, opioid use by dose and duration for members diagnosed with OUD. Over these years, a decrease of 19% of total Opioid RX fills; shorter durations and the majority of these members switched to 7 days or less of opioid use; and a reduction by 13 percentage point of the number of members on higher strength 20+ MMEs opioids resulted.

Conclusion:

These findings may help inform nationwide opioid-focused efforts and set priorities.

Keywords: Health system, Three-prolonged strategy, Opioid epidemic, Opioid use disorder, Opioid prescription, Crisis.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 152
Last Page: 160
Publisher Id: TOPHJ-13-152
DOI: 10.2174/1874944502013010152

Article History:

Received Date: 13/11/2019
Revision Received Date: 05/02/2020
Acceptance Date: 08/02/2020
Electronic publication date: 24/04/2020
Collection year: 2020

© 2020 De Shazer et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Correspondence: Address correspondence to this author at the Health Plan Chief Medical Officer (CMO) Organization, Highmark Inc., Pittsburgh, PA, USA; Tel: (412) 544-6800;
E-mail: oralia.dominic@highmark.com




Track Your Manuscript:


Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2020 Bentham Open