Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Ling SM [original query] |
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Overdose, behavioral health services, and medications for opioid use disorder after a nonfatal overdose
Jones CM , Shoff C , Blanco C , Losby JL , Ling SM , Compton WM . JAMA Intern Med 2024 IMPORTANCE: Recognizing and providing services to individuals at highest risk for drug overdose are paramount to addressing the drug overdose crisis. OBJECTIVE: To examine receipt of medications for opioid use disorder (MOUD), naloxone, and behavioral health services in the 12 months after an index nonfatal drug overdose and the association between receipt of these interventions and fatal drug overdose. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in the US from January 2020 to December 2021 using claims, demographic, mortality, and other data from the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and other sources. The cohort comprised Medicare fee-for-service beneficiaries aged 18 years or older with International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes for a nonfatal drug overdose. Data analysis was performed from February to November 2023. EXPOSURES: Demographic and clinical characteristics, substance use disorder, and psychiatric comorbidities. MAIN OUTCOMES AND MEASURES: Receipt of MOUD, naloxone, and behavioral health services as well as subsequent nonfatal and fatal drug overdoses. RESULTS: The cohort consisted of 136 762 Medicare beneficiaries (80 140 females [58.6%]; mean (SD) age of 68.2 [15.0] years) who experienced an index nonfatal drug overdose in 2020. The majority of individuals had Hispanic (5.8%), non-Hispanic Black (10.9%), and non-Hispanic White (78.8%) race and ethnicity and lived in metropolitan areas (78.9%). In the 12 months after their index nonfatal drug overdose, 23 815 beneficiaries (17.4%) experienced at least 1 subsequent nonfatal drug overdose and 1323 (1.0%) died of a fatal drug overdose. Opioids were involved in 72.2% of fatal drug overdoses. Among the cohort, 5556 (4.1%) received any MOUD and 8530 (6.2%) filled a naloxone prescription in the 12 months after the index nonfatal drug overdose. Filling a naloxone prescription (adjusted odds ratio [AOR], 0.70; 95% CI, 0.56-0.89), each percentage of days receiving methadone (AOR, 0.98; 95% CI, 0.98-0.99) or buprenorphine (AOR, 0.99; 95% CI, 0.98-0.99), and receiving behavioral health assessment or crisis services (AOR, 0.25; 95% CI, 0.22-0.28) were all associated with reduced adjusted odds of fatal drug overdose in the 12 months after the index nonfatal drug overdose. CONCLUSIONS AND RELEVANCE: This cohort study found that, despite their known association with reduced risk of a fatal drug overdose, only a small percentage of Medicare beneficiaries received MOUD or filled a naloxone prescription in the 12 months after a nonfatal drug overdose. Efforts to improve access to behavioral health services; MOUD; and overdose-prevention strategies, such as prescribing naloxone and linking individuals to community-based health care settings for ongoing care, are needed. |
Association of receipt of opioid use disorder-related telehealth services and medications for opioid use disorder with fatal drug overdoses among Medicare beneficiaries before and during the COVID-19 Pandemic
Jones CM , Shoff C , Blanco C , Losby JL , Ling SM , Compton WM . JAMA Psychiatry 2023 80 (5) IMPORTANCE: Federal emergency authorities were invoked during the COVID-19 pandemic to expand clinical telehealth for opioid use disorder (OUD). OBJECTIVE: To examine the association of the receipt of telehealth services and medications for OUD (MOUD) with fatal drug overdoses before and during the pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used exploratory longitudinal data from 2 cohorts (prepandemic cohort: September 1, 2018, to February 29, 2020; pandemic cohort: September 1, 2019, to February 28, 2021) of Medicare Fee-for-Service beneficiaries aged 18 years or older initiating an episode of OUD-related care using Medicare Fee-for-Service data from the Centers for Medicare & Medicaid Services and National Death Index data from the Centers for Disease Control and Prevention. Data analysis was performed from September 19 to October 17, 2022. EXPOSURES: Prepandemic vs pandemic cohort demographic, medical, substance use, and psychiatric characteristics. MAIN OUTCOMES AND MEASURES: Receipt of OUD-related telehealth services, receipt of MOUD, and fatal drug overdose. RESULTS: The prepandemic cohort comprised 105 162 beneficiaries (58.1% female; 67.6% aged 45-74 years). The pandemic cohort comprised 70 479 beneficiaries (57.1% female; 66.3% aged 45-74 years). The rate of all-cause mortality was higher in the pandemic cohort (99.9 per 1000 beneficiaries; 7041 deaths) than in the prepandemic cohort (76.8 per 1000; 8076 deaths) (P < .001). The rate of fatal drug overdoses was higher in the pandemic cohort (5.1 per 1000 beneficiaries; n = 358) than in the prepandemic cohort (3.7 per 1000; n = 391) (P < .001). The percentage of deaths due to a fatal drug overdose was similar in the prepandemic (4.8%) and pandemic (5.1%) cohorts (P = .49). In multivariable analysis of the pandemic cohort, receipt of OUD-related telehealth was associated with a significantly lower adjusted odds ratio (aOR) for fatal drug overdose (aOR, 0.67; 95% CI, 0.48-0.92) as was receipt of MOUD from opioid treatment programs (aOR, 0.41; 95% CI, 0.25-0.68) and receipt of buprenorphine in office-based settings (aOR, 0.62; 95% CI, 0.43-0.91) compared with those not receiving MOUD; receipt of extended-release naltrexone in office-based settings was not associated with lower odds for fatal drug overdose (aOR, 1.16; 95% CI, 0.41-3.26). CONCLUSIONS AND RELEVANCE: This cohort study found that, among Medicare beneficiaries initiating OUD-related care during the COVID-19 pandemic, receipt of OUD-related telehealth services was associated with reduced risk for fatal drug overdose, as was receipt of MOUD from opioid treatment programs and receipt of buprenorphine in office-based settings. Strategies to expand provision of MOUD, increase retention in care, and address co-occurring physical and behavioral health conditions are needed. |
Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic.
Jones CM , Shoff C , Hodges K , Blanco C , Losby JL , Ling SM , Compton WM . JAMA Psychiatry 2022 79 (10) 981-992 IMPORTANCE: Federal emergency authorities were invoked during the COVID-19 pandemic to expand use of telehealth for new and continued care, including provision of medications for opioid use disorder (MOUD). OBJECTIVE: To examine receipt of telehealth services, MOUD (methadone, buprenorphine, and extended-release [ER] naltrexone) receipt and retention, and medically treated overdose before and during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This exploratory longitudinal cohort study used data from the US Centers for Medicare & Medicaid Services from September 2018 to February 2021. Two cohorts (before COVID-19 pandemic from September 2018 to February 2020 and during COVID-19 pandemic from September 2019 to February 2021) of Medicare fee-for-service beneficiaries 18 years and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis. EXPOSURES: Pre-COVID-19 pandemic vs COVID-19 pandemic cohort demographic characteristics, medical and substance use, and psychiatric comorbidities. MAIN OUTCOMES AND MEASURES: Receipt and retention of MOUD, receipt of OUD and behavioral health-related telehealth services, and experiencing medically treated overdose. RESULTS: The pre-COVID-19 pandemic cohort comprised 105 240 beneficiaries; of these, 61 152 (58.1%) were female, 71 152 (67.6%) were aged 45 to 74 years, and 82 822 (79.5%) non-Hispanic White. The COVID-19 pandemic cohort comprised 70 538 beneficiaries; of these, 40 257 (57.1%) were female, 46 793 (66.3%) were aged 45 to 74 years, and 55 510 (79.7%) were non-Hispanic White. During the study period, a larger percentage of beneficiaries in the pandemic cohort compared with the prepandemic cohort received OUD-related telehealth services (13 829 [19.6%] vs 593 [0.6%]; P < .001), behavioral health-related telehealth services (28 902 [41.0%] vs 1967 [1.9%]; P < .001), and MOUD (8854 [12.6%] vs 11 360 [10.8%]; P < .001). The percentage experiencing a medically treated overdose during the study period was similar (18.5% [19 491 of 105 240] in the prepandemic cohort vs 18.4% [13 004 of 70 538] in the pandemic cohort; P = .65). Receipt of OUD-related telehealth services in the pandemic cohort was associated with increased odds of MOUD retention (adjusted odds ratio [aOR], 1.27; 95% CI, 1.14-1.41) and lower odds of medically treated overdose (aOR, 0.67; 95% CI, 0.63-0.71). Among beneficiaries in the pandemic cohort, those receiving MOUD from opioid treatment programs only (aOR, 0.54; 95% CI, 0.47-0.63) and those receiving buprenorphine from pharmacies only (aOR, 0.91; 95% CI, 0.84-0.98) had lower odds of medically treated overdose compared with beneficiaries who did not receive MOUD. CONCLUSIONS AND RELEVANCE: Emergency authorities to expand use of telehealth and provide flexibilities for MOUD provision during the pandemic were used by Medicare beneficiaries initiating an episode of OUD-related care and were associated with improved retention in care and reduced odds of medically treated overdose. Strategies to expand provision of MOUD and increase retention in care are urgently needed. |
Opportunities to enhance the utility of cause of death information from death certificates
Ling SM , Warner M , Anderson RN . Am J Public Health 2022 112 S42-s44 In this issue of AJPH, Merlin et al. (p. S36) describe the implications for improved reporting of cause of death (COD) as it applies to the opioid crisis. They go on to suggest that the current death certificate process forces a chain of linear, single diagnoses, and to suggest the enhancement of processes to improve the accuracy and validity of COD data. While a single, underlying cause is still desirable from a statistical standpoint to avoid double counting of deaths in tabulations, the authors are correct that the underlying cause does not always adequately describe the complexity of COD, especially for decedents with multiple comorbid diseases and other health conditions. |
Advancing the science of healthcare service delivery: The NHLBI Corporate Healthcare Leaders' Panel
Sampson UKA , McGlynn EA , Perlin JB , Frisse ME , Arnold SB , Benz EJJr , Brennan T , Briss P , Beeuwkes Buntin MJ , Khosla S , King RG , Kuntz R , Leider H , Ling SM , Macrae J , Murray R , Thrailkill E , Wager C , Witchey D , Jacobson HR . Glob Heart 2018 13 (4) 339-345 There is a growing gap between available science and evidence and the ability of service providers to deliver high-quality care in a cost-effective way to the entire population. We believe that the chasm between knowledge and action is due to a lack of concerted effort among all organizations that deliver health care services across the life span of patients. Broad participation is needed and necessitates a far more explicit and concerted public-private partnership focused on large-scale transformation. In this context, the National Heart, Lung, and Blood Institute convened a panel made up of leaders of corporate health care entities, including academic health centers, and government agency representatives to inform contemporary strategic partnerships with health care companies. This article provides insights from the meeting on how to execute a transformative innovation research agenda that will foster improvements in health care service delivery by leveraging the translation of biomedical research evidence in real-world settings. |
Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011-2013
Goodman RA , Lochner KA , Thambisetty M , Wingo TS , Posner SF , Ling SM . Alzheimers Dement 2017 13 (1) 28-37 INTRODUCTION: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. METHODS: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). RESULTS: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. DISCUSSION: This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources. |
Multimorbidity patterns in the United States: implications for research and clinical practice
Goodman RA , Ling SM , Briss PA , Parrish RG , Salive ME , Finke BS . J Gerontol A Biol Sci Med Sci 2015 71 (2) 215-20 The increasing prevalence of persons with multimorbidity in many countries has sparked strong growth in research on the epidemiology of multimorbidity, in part to help improve approaches to preventing and managing chronic conditions ( 1–6 ). In this issue of the Journal , Garin and colleagues have made a major contribution to this field of research by examining nationally representative data from studies of noninstitutionalized, predominantly older adults in nine countries that represent the socioeconomic spectrum, and by using a common set of 12 chronic conditions to characterize epidemiologic patterns of multimorbidity among older adults in those countries ( 7 ). | Particularly noteworthy are their results for the relation between multimorbidity and sociodemographic factors (age, sex, education, marital status, wealth, and place of residence), as well as the most prevalent comorbid conditions (hypertension, arthritis, and cataract). In addition, their analysis identified selected multimorbidity combinations for each country and across countries, the most common of which are “cardio-respiratory” and “metabolic” patterns. |
CDC Grand Rounds: getting smart about antibiotics
Demirjian A , Sanchez GV , Finkelstein JA , Ling SM , Srinivasan A , Pollack LA , Hicks LA , Iskander JK . MMWR Morb Mortal Wkly Rep 2015 64 (32) 871-873 Each year in the United States, approximately two million persons become infected with antibiotic-resistant bacteria, at least 23,000 persons die as a direct result of these infections, and many more die from conditions complicated by a resistant infection. Antibiotic-resistant infections contribute to poor health outcomes, higher health care costs, and use of more toxic treatments. Although emerging resistance mechanisms are being identified and resistant infections are on the rise, new antibiotic development has slowed considerably. |
Telomere Length as an Indicator of the Robustness of B- and T-Cell Response to Influenza in Older Adults.
Najarro K , Nguyen H , Chen G , Xu M , Alcorta S , Yao X , Zukley L , Metter EJ , Truong T , Lin Y , Li H , Oelke M , Xu X , Ling SM , Longo DL , Schneck J , Leng S , Ferrucci L , Weng NP . J Infect Dis 2015 212 (8) 1261-9 BACKGROUND: Telomeres provide a key mechanism for protecting the integrity of chromosomes and their attrition after cell division and during aging are evident in lymphocytes. However, the significance of telomere shortening in age-associated decline of immune function is unknown. METHODS: We selected 22 HLA-A2+ healthy older adults who have relatively short or long telomere lengths to compare their antibody response against the influenza vaccine, and their CD8+ T cell response against an influenza antigen. RESULTS: B cells from individuals with a robust antibody response to the influenza vaccine had significantly longer telomeres than those with a poor antibody response. Monocyte-derived antigen-presenting cells of both short and long telomere groups induced similar expansions of influenza M1-specific CD8+ T cells. Vaccination did not increase M1-specific CD8+ T cells in blood, however, M1-specific CD8+ T cells from the long telomere group exhibited significantly better expansion in vitro compared to those from the short telomere group. Finally, M1-specific CD8+ T cells that underwent more expansions had significantly longer telomeres compared to cells with fewer divisions. CONCLUSIONS: Telomere length is positively associated with a robust lymphocyte response and telomere attrition may contribute to the age-associated decline of adaptive immunity. |
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