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      Treatment for opioid use disorder in the Florida medicaid population: Using a cascade of care model to evaluate quality

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          Abstract

          Background: A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing to provide appropriate care for people with opioid use disorder (OUD) diagnoses, and to assess disparities in receipt of medication for OUD (MOUD).Objective: Using a CoC framework, assess treatment quality and outcomes for OUD in the Florida Medicaid population in 2017/2018 by demographics and primary vs. secondary diagnosis.Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began MOUD, were retained on medication for a minimum of 180 days, and who died.Results: Only 28% of those diagnosed with OUD began treatment with an FDA approved MOUD (buprenorphine, methadone, or injectable naltrexone). Once on medication, 38% of newly diagnosed enrollees were retained in treatment for180 days. Those who remained on MOUD for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate MOUD, a reduction in mortality from 10% without MOUD to 2% with MOUD.Conclusions: Initiating medication after OUD diagnosis offers the greatest opportunity for intervention to reduce overdose deaths, though efforts to increase retention are also warranted. Analyzing claims data with CoC identifies system functioning for specific populations, and suggests policies and clinical pathways to target for improvement.

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          Author and article information

          Contributors
          (View ORCID Profile)
          Journal
          The American Journal of Drug and Alcohol Abuse
          The American Journal of Drug and Alcohol Abuse
          Informa UK Limited
          0095-2990
          1097-9891
          March 04 2021
          October 15 2020
          March 04 2021
          : 47
          : 2
          : 220-228
          Affiliations
          [1 ]College of Behavioral and Community Science, Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
          [2 ]Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
          [3 ]Division of Public Mental Health and Population Sciences, Department of Psychiatry, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
          Article
          10.1080/00952990.2020.1824236
          8046836
          33054435
          139d7cca-5561-49f2-a9b8-7cbec529e292
          © 2021
          History

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