Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada
Abstract Objectives We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post‐emergency department (post‐ED) visits. Methods We analyzed 1.5 years (July 1, 2020–December 31, 2021) of encounter‐level Medicaid ED and retail pharmacy claims data obtained f...
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Elsevier
2024-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13272 |
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| author | Olufemi Ajumobi Sarah Friedman John Westhoff Michelle Granner Julie Lucero Brandon Koch Karla D. Wagner |
| author_facet | Olufemi Ajumobi Sarah Friedman John Westhoff Michelle Granner Julie Lucero Brandon Koch Karla D. Wagner |
| author_sort | Olufemi Ajumobi |
| collection | DOAJ |
| description | Abstract Objectives We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post‐emergency department (post‐ED) visits. Methods We analyzed 1.5 years (July 1, 2020–December 31, 2021) of encounter‐level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter. Results Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14‐day window: adjusted odds ratio (aOR) = 0.965, 95% confidence interval [CI]: 0.948–0.983) and being a Black patient (14‐day window: aOR: 0.114, 95% CI 0.036–0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit. Conclusions Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates. |
| format | Article |
| id | doaj-art-cdac0cb4fd474919bdfd2565bef15995 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-cdac0cb4fd474919bdfd2565bef159952025-08-20T03:19:38ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522024-10-0155n/an/a10.1002/emp2.13272Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in NevadaOlufemi Ajumobi0Sarah Friedman1John Westhoff2Michelle Granner3Julie Lucero4Brandon Koch5Karla D. Wagner6School of Public Health University of Nevada Reno Nevada USASchool of Public Health University of Nevada Reno Nevada USADepartment of Internal Medicine University of Nevada Reno School of Medicine Reno Nevada USASchool of Public Health University of Nevada Reno Nevada USACollege of Health University of Utah Salt Lake City Utah USACollege of Public Health The Ohio State University Columbus Ohio USASchool of Public Health University of Nevada Reno Nevada USAAbstract Objectives We described age, gender, race, and ethnicity associations with filling buprenorphine prescriptions post‐emergency department (post‐ED) visits. Methods We analyzed 1.5 years (July 1, 2020–December 31, 2021) of encounter‐level Medicaid ED and retail pharmacy claims data obtained from the Nevada Department of Health and Human Services. We studied ED patients with an opioid use disorder (OUD) diagnosis who did not fill a prescription for OUD medications within 6 months before the ED encounter. Using logistic regression, we modeled the associations between the patient's demographic characteristics and the outcome, filling a buprenorphine prescription at a community pharmacy within 14 or 30 days of the ED encounter. Results Among 2781 ED visits, representing 2094 patients, the median age was 39 years, 54% were male, 18.5% were Black, 11.7% were Hispanic, and 62.3% were White. Only 4% of the ED visits were followed by a filled buprenorphine prescription. Increasing age (14‐day window: adjusted odds ratio (aOR) = 0.965, 95% confidence interval [CI]: 0.948–0.983) and being a Black patient (14‐day window: aOR: 0.114, 95% CI 0.036–0.361) were both associated with lower odds of filled buprenorphine prescriptions. These results were similar within 30 days of an ED visit. Conclusions Initiation of buprenorphine following an ED visit remains low among Nevadan Medicaid patients and is less likely with increasing age and among Black patients, despite strong evidence supporting its use. Overburdened EDs, lack of attention from managers, and substance use stigma are among possible explanations. When ED clinicians do write buprenorphine prescriptions, peer recovery support could increase the fill rates.https://doi.org/10.1002/emp2.13272buprenorphineemergency departmentMedicaidopioid use disorder |
| spellingShingle | Olufemi Ajumobi Sarah Friedman John Westhoff Michelle Granner Julie Lucero Brandon Koch Karla D. Wagner Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada Journal of the American College of Emergency Physicians Open buprenorphine emergency department Medicaid opioid use disorder |
| title | Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada |
| title_full | Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada |
| title_fullStr | Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada |
| title_full_unstemmed | Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada |
| title_short | Age and racial and ethnic disparities in filled buprenorphine prescriptions post‐emergency department visit in Nevada |
| title_sort | age and racial and ethnic disparities in filled buprenorphine prescriptions post emergency department visit in nevada |
| topic | buprenorphine emergency department Medicaid opioid use disorder |
| url | https://doi.org/10.1002/emp2.13272 |
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