ABSTRACT
Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits the ability of employers to knowledgeably develop or implement benefit design decisions. This study uses medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, and allows an easy comparison of hospital prices using a single metric. An important innovation of this study is that our data use agreements allow reporting on prices paid to hospitals and hospital systems (hospitals under joint ownership) identified by name.
ABSTRACT
PURPOSE: To examine the prevalence of rapid discontinuation of chronic, high-dose opioid analgesic treatment, and identify associated patient, clinician, and community factors. METHODS: Using 2017-2018 retail pharmacy claims data from IQVIA, we identified chronic, high-dose opioid analgesic treatment episodes discontinued during these years and determined the percent of episodes meeting criteria for rapid discontinuation. We used multivariable logistic regression to estimate the probability of rapid discontinuation, conditional on having a discontinued chronic, high-dose opioid treatment episode, as a function of patient, provider, and county characteristics. RESULTS: We identified 810,120 new, chronic, high-dose opioid treatment episodes discontinued in 2017 or 2018, of which 72.0% (n=583,415) were rapidly discontinued. Rapid discontinuation was significantly more likely among Medicare (aOR 1.14, 95% CI 1.12 to 1.15) and Medicaid enrollees (aOR 1.03, 95% CI 1.02 to 1.05) compared to the commercially insured; in counties with higher fatal overdose rates (aOR 1.03, 95% CI 1.01 to 1.04) compared to counties with the lowest fatal overdose rates; and in counties with a higher percentage of non-white residents (aOR 1.21 for counties in the highest quartile relative to the lowest, 95% CI 1.19 to 1.24). Likelihood of rapid discontinuation also varied by prescriber specialty. CONCLUSIONS: Most chronic, high-dose opioid treatment episodes that ended in 2017 or 2018 were discontinued more rapidly than recommended by clinical guidelines, raising concerns about adverse patient outcomes. Our findings highlight the need to understand what drives discontinuation and to inform safer opioid tapering and discontinuation practices.
Subject(s)
Chronic Pain , Drug Overdose , Opioid-Related Disorders , Aged , Analgesics, Opioid/adverse effects , Chronic Pain/drug therapy , Chronic Pain/epidemiology , Drug Overdose/drug therapy , Humans , Medicare , Opioid-Related Disorders/epidemiology , Pain/drug therapy , Prevalence , United States/epidemiologyABSTRACT
The present study evaluates the personal values reported by a sample of New York Hispanic residents using an open evaluation format in which the participants identified and prioritized their personal values. Four hundred and forty-five participants were assigned to one of three groups: Young (N= 159), Adult (N= 168) and Senior (N= 118). The values reported were categorized into post-materialist, materialist or non-classifiable. The Percentage Difference Index between post-materialist and materialist values was calculated in order to determine the value profile for each age group. The results showed that reports of personal values and values attributed to the participants' own generation were similar in Adult and Senior groups, but were very different in the Young Group, with a differential report of post-materialist values. Furthermore, exposure to American culture did not appear to have a significant effect on the reported values of NYC Hispanics. To confirm these findings, we need to conduct additional studies with larger samples of culturally diverse populations.
Se exploran los valores en una muestra de hispanos de New York, empleando un formato abierto en el que los participantes identifican y priorizan su valores personales y los de su generación. Los 445 participantes se distribuyeron en tres grupos: Jóvenes (N = 159), Adultos (N = 168) y Mayores (N = 118). Los informes de valores se categorizaron como postmaterialistas, materialistas o no clasificables, y se calculó el Percentage Difference Index entre valores postmaterialistas y materialistas para determinar el perfil de valores de cada grupo. Los resultados mostraron que los informes de valores personales y generacionales fueron similares en los grupos Adulto y Mayor, y diferentes en el Grupo Joven con un reporte diferencial entre valores personales y generacionales. Por otro lado, el tiempo vivido bajo la influencia de la cultura norteamericana parece no tener un efecto significativo en el informe de valores para esta población. Para confirmar estos hallazgos son necesarios estudios adicionales con muestras más amplias y en poblaciones culturalmente diversas.
Subject(s)
Psychology , Psychometrics , Reference ValuesABSTRACT
The purpose of this article is to analyze the evolution of the International Journal of Psychology & Psychological Therapy (IJP&PT) throughout its first decade of publication (from years 2001 to 2010), comparing the quality measures that result from applying the three most important social science databases: Thomson-Reuters Web of Science, Elsevier-Scopus, and Google Scholar. We compared the three databases, using the citations recorded for IJP&PT as a "case study" applied to a journal. As quality indicators we used IJP&PT data available in the three databases, as well as other indicators related to the internationality of the journal. The results shows a increasing tend in all quality criteria during the time period evaluated as a first-level journal among psychology journals edited in Spain. Also, the results shows serious discrepancies when the data of the three databases are compared. We discuss the need to improve the criteria used by the databases, as well as the convenience to use several quality indicators for journals evaluation (AU)
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