PATIENT, HOSPITAL AND STATE-LEVEL POLICY CHARACTERISTICS ASSOCIATED WITH PREVALENCE OF TREATING OPIOID USE DISORDER IN UNITED STATES EMERGENCY DEPARTMENTS

The opioid crisis in the United States was declared a public health emergency due to escalating and untoward human, financial, and systemic consequences and effects on the nation. Opioid use disorder (OUD) comprising opioid abuse and dependence is devastating because of its associated chronic relapsing nature, overutilization of healthcare services, rising morbidity and mortality rates, and high cost of care. Efforts to address this have not made significant positive impacts. It is thus imperative to reassess the influence of factors associated with OUD. This study answered the question, what patient-, hospital-, and state-level policy factors were associated with prevalence of diagnosing and treating OUD in U.S. emergency departments (ED), since the ED which were usually first point-of-contact with the healthcare system by patients with OUD witnessed significantly increased visits related to nonmedical use of opioids. A retrospective secondary data analysis of the cross-sectional Nationwide Emergency Department Sample of patients 12 years and older from January 1 to December 31, 2016; ASAM state reports; SAMHSA Office of Policy, Planning and Innovation State Medicaid coverage reports; and KFF report on opioid epidemic was performed. Outcome variable was prevalence of diagnosing and treating OUD in the ED. Primary predictor variable was OUD condition, and covariates included, patient characteristics – primary payer, annual median income, patient location, and ED event; hospital characteristics – control/ownership, region, and designation; and state-level policy characteristics – medication-assisted treatment (MAT) policy, MAT medication coverage, Medicaid expansion, and Medicaid section 1115 behavioral health waiver statuses. Descriptive statistics was reported for all variables. Pearson’s chi-squared was test used to determine statistically significant differences between opioid abuse and opioid dependence diagnosis. Hierarchical linear regression model (HLM) was used to estimate association between outcome and predictor variables. In total, 32,680,232 ED visits in 953 hospitals across 35 states and District of Columbia which when generalized to the entire United States amounted to 144,842,742 visits to the ED in 4,639 hospitals across the 50 states including the District of Columbia were analyzed. The total number of opioid-related incidents to the ED was 1,623,490. The overall prevalence of any opioid-related incident was 1.12% while overall prevalence of diagnosis and treatment of uncomplicated OUD in U.S. ED was 0.5%. Significant regional disparities existed in state-level opioid policies, prevalence of uncomplicated OUD and other characteristics influencing treatment of OUD in U.S. ED. Opioid dependence patients (55.6%) were preponderantly of upper-lower income class, micropolitan residents, covered by Medicare; admitted to same hospital they presented, attended to largely in privately owned not-for-profit ED, in micropolitan areas, and in Southern and Western U.S. Opioid abuse patients (44.4%) were predominantly of lower-lower income status, metropolitan dwellers, Medicaid covered; presented commonly to privately-owned not-for-profit ED, in metropolitan locations, and in Northeastern and Midwestern U.S. Combined, patient and hospital-level policy characteristics accounted for 25.4% (R2=0.254, Adj. R2=0.254, F change (3,734618)=31937.906, p\u3c0.0001) of variance in prevalence of treating OUD in ED. Patient characteristics only accounted for 15.6% (R2=0.156, Adj. R2=0.156, F(5,734621)=27245.686, p\u3c0.0001) and hospital characteristics only for 9.7% (R2 change=0.097, F(3,734618)=31937.906, p\u3c0.0001) of the variance. Proportion of variance accounted for by each predictor variable was, control/ownership of hospital (9.67%), patient location (6.35%), annual median income (1.44%), hospital designation (1.21%), OUD diagnosis (0.20%), primary payer (0.04%), region of hospital (0.02%), and ED event (0.008%). Patient and hospital level characteristics significantly influenced prevalence of treating OUD in U.S. ED. Hospital-level characteristics contributed more that patient-level characteristics. A socioecological approach, which ensures an integrated and holistic method, is required to understand factors influencing OUD with the view to developing innovative policies and programs that can positively and significantly address the opioid crisis

Effectiveness of human mobility change in reducing the spread of COVID-19: ecological study of Kingdom of Saudi Arabia

Non-pharmacological interventions including mobility restriction have been developed to curb transmission of SARS-CoV-2. We provided precise estimates of disease burden and examined the impact of mobility restriction on reducing the COVID-19 effective reproduction number in the Kingdom of Saudi Arabia. This study involved secondary analysis of open-access COVID-19 data obtained from different sources between 2 March and 26 December 2020. The dependent and main independent variables of interest were the effective reproduction number and anonymized mobility indices, respectively. Multiple linear regression was used to investigate the relationship between the community mobility change and the effective reproduction number for COVID-19. By 26 December 2020, the total number of COVID-19 cases in Saudi Arabia reached 360,690, with a cumulative incidence rate of 105.41/10,000 population. Al Jouf, Northern Border, and Jazan regions were ≥2.5 times (OR = 2.93; 95% CI: 1.29–6.64), (OR = 2.50; 95% CI: 1.08–5.81), and (OR = 2.51; 95% CI: 1.09–5.79) more likely to have a higher case fatality rate than Riyadh, the capital. Mobility changes in public and residential areas were significant predictors of the COVID-19 effective reproduction number. This study demonstrated that community mobility restrictions effectively control transmission of the COVID-19 virus

Trends in demography, risk assessment, and prevalence of pressure sores in nursing home active residents in state of Texas between 2011 and 2015

Pressure sores are preventable and treatable public health problems occurring worldwide. In spite of advances in medicine and technology, pressure sore are still a cause for concern across all healthcare settings in general and nursing homes in particular. There are enormous morbidity, mortality, and financial burdens placed on the healthcare system of the United States that are attributable to pressure sores and associated complications. The State of Texas in spite of being a state with the second highest gross domestic product by state in the United State and its nursing homes are not immune to the problem of pressure sores. Texas nursing homes ranked 51 (worst overall) in 2014 and pressure sores were one of the quality measures used to determine this ranking. Thus analyzing trends associated with pressure sores in Texas nursing homes and comparing it with trends at the national level may provide relevant information needed for nursing homes in Texas to improve the quality and process of care particularly for pressure sores within their establishments. To this end, in this study, a secondary analysis was conducted on data collected on all active nursing home residents in the United States with specific focus on the State of Texas. These data are stored in the form of reports in a national Minimum Data Set repository managed by the Centers for Medicare and Medicaid Services – the Minimum Data Set (MDS) 3.0 Frequency Reports. The research questions that guided this study were, for active residents in Texas nursing homes from fourth quarter of 2011 to first quarter of 2015, what were the trends in demographic characteristics? Risk assessment characteristics regarding pressure sores? Point prevalence of pressure sores? The results of this study indicate that overall the trends in demography, risk assessment, and prevalence of pressure sores in nursing home active residents in the State of Texas between the fourth quarter of 2011 and first quarter of 2015 are similar to trends occurring nationally. However, there is beginning to be an increase in the population of ethnic/racial minorities and male residents in nursing homes, decrease in the number of widowed residents, significant difference between the trend of using clinical judgment and tool-based risk assessment for determining pressure sore risk, and difference in trend between the point prevalence of pressure sores in Texas and nationally. This study has shown that it is imperative for nursing homes in Texas and nationally to continuously strive to improve on the quality and process of care within their establishment in order to improve further on the care of pressure sores and to cope with the rising population of residents