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  1. Article ; Online: Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors.

    Wittman, Samuel R / Hoberman, Alejandro / Mehrotra, Ateev / Sabik, Lindsay M / Yabes, Jonathan G / Ray, Kristin N

    JAMA network open

    2024  Volume 7, Issue 3, Page(s) e242359

    Abstract: Importance: Prior research found that pediatric direct-to-consumer (DTC) telemedicine visits are associated with more antibiotic prescribing than in-person primary care visits. It is unclear whether this difference is associated with modality of care ( ... ...

    Abstract Importance: Prior research found that pediatric direct-to-consumer (DTC) telemedicine visits are associated with more antibiotic prescribing than in-person primary care visits. It is unclear whether this difference is associated with modality of care (telemedicine vs in-person) or with the context of telemedicine care (primary care vs not primary care).
    Objective: To compare antibiotic management during telemedicine visits with primary care practitioners (PCPs) vs commercial direct-to-consumer (DTC) telemedicine companies for pediatric acute respiratory tract infections (ARTIs).
    Design, setting, and participants: This retrospective, cross-sectional study of visits for ARTIs by commercially insured children 17 years of age or younger analyzed deidentified medical and pharmacy claims in OptumLabs Data Warehouse data, a national sample of commercial enrollees, between January 1 and December 31, 2022.
    Exposure: Setting of telemedicine visit as PCP vs DTC.
    Main outcomes and measures: The primary outcome was percentage of visits with antibiotic receipt. Secondary outcomes were the percentages of visits with diagnoses for which prescription of an antibiotic was potentially appropriate, guideline-concordant antibiotic management, and follow-up ARTI visits within the ensuing 1 to 2 days and 3 to 14 days. The ARTI telemedicine visits with PCP vs DTC telemedicine companies were matched on child demographic characteristics. Generalized estimated equation log-binomial regression models were used to compute marginal outcomes.
    Results: In total, data from 27 686 children (mean [SD] age, 8.9 [5.0] years; 13 893 [50.2%] male) were included in this study. There were 14 202 PCP telemedicine index visits matched to 14 627 DTC telemedicine index visits. The percentage of visits involving receipt of an antibiotic was lower for PCP (28.9% [95% CI, 28.1%-29.7%]) than for DTC (37.2% [95% CI, 36.0%-38.5%]) telemedicine visits. Additionally, fewer PCP telemedicine visits involved receipt of a diagnosis in which the use of antibiotics may be appropriate (19.0% [95% CI, 18.4%-19.7%] vs 28.4% [95% CI, 27.3%-29.6%]), but no differences were observed in receipt of nonguideline-concordant antibiotic management based on a given diagnosis between PCP (20.2% [95% CI, 19.5%-20.9%]) and DTC (20.1% [95% CI, 19.1%-21.0%]) telemedicine visits. Fewer PCP telemedicine visits involved a follow-up visit within the ensuing 1 to 2 days (5.0% [95% CI, 4.7%-5.4%] vs 8.0% [95% CI, 7.3%-8.7%]) and 3 to 14 days (8.2% [95% CI, 7.8%-8.7%] vs 9.6% [95% CI, 8.8%-10.3%]).
    Conclusions and relevance: Compared with virtual-only DTC telemedicine companies, telemedicine integrated within primary care was associated with lower rates of antibiotic receipt and follow-up care. Supporting use of telemedicine integrated within pediatric primary care may be one strategy to reduce antibiotic receipt through telemedicine visits.
    MeSH term(s) Humans ; Child ; Male ; Female ; Cross-Sectional Studies ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use ; Respiratory Tract Infections/drug therapy ; Telemedicine ; Primary Health Care
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2024-03-04
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2024.2359
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  2. Article ; Online: Prevalence and risk factors for bleeding in hereditary hemorrhagic telangiectasia: a National Inpatient Sample study.

    Zarka, Jabra / Jeong, Kwonho / Yabes, Jonathan G / Ragni, Margaret V

    Blood advances

    2023  Volume 7, Issue 19, Page(s) 5843–5850

    Abstract: Hereditary hemorrhagic telangiectasia (HHT) is a common bleeding disorder, but little is known regarding prevalence and risk factors for bleeding. Adult discharges with HHT and bleeding were identified by International Classification of Disease, 10th ... ...

    Abstract Hereditary hemorrhagic telangiectasia (HHT) is a common bleeding disorder, but little is known regarding prevalence and risk factors for bleeding. Adult discharges with HHT and bleeding were identified by International Classification of Disease, 10th edition (ICD-10) codes in the National Inpatient Sample (NIS), 2016-2018. Prevalence estimates were weighted using NIS discharge-level weights to reflect national estimates. Risk factors for bleeding were determined by weighted multivariable logistic regression. Among 18 170 849 discharges, 2528 (0.01%) had HHT, of whom 648 (25.6%) had bleeding. Arteriovenous malformation (AVM) (31.9% vs 1.3%), angiodysplasia (23.5% vs 2.3%), telangiectasia (2.3% vs 0.2%), and epistaxis (17.9% vs 0.6%) were more common in HHT than in non-HHT patients (non-HHT), each P < .001. In contrast, menstrual (HMB) and postpartum bleeding (PPH) were less common in reproductive-age HHT than non-HHT, each P < .001. Anemia associated with iron deficiency (IDA), was equally common in HHT with or without bleeding (15.7% vs 16.0%), but more common than in non-HHT (7.5%), P < .001. Comorbidities, including gastroesophageal reflux (25.9% vs 20.0%) and cirrhosis (10.0% vs 3.6%) were greater in HHT than non-HHT, each P < .001. In multivariable logistic regression, peptic ulcer disease (OR, 8.86; P < .001), portal vein thrombosis (OR, 3.68; P = .006), and hepatitis C, (OR, 2.13; P = .017) were significantly associated with bleeding in HHT. In conclusion, AVM and angiodysplasia are more common and HMB and PPH less common in patients in those with HHT than non-HHT. IDA deficiency is as common in HHT with and without bleeding, suggesting ongoing blood loss and need for universal iron screening.
    Language English
    Publishing date 2023-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2915908-8
    ISSN 2473-9537 ; 2473-9529
    ISSN (online) 2473-9537
    ISSN 2473-9529
    DOI 10.1182/bloodadvances.2023010743
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  3. Article ; Online: Intensivist physician-to-patient ratios and mortality in the intensive care unit.

    Kahn, Jeremy M / Yabes, Jonathan G / Bukowski, Leigh A / Davis, Billie S

    Intensive care medicine

    2023  Volume 49, Issue 5, Page(s) 545–553

    Abstract: Purpose: A high daily census may hinder the ability of physicians to deliver quality care in the intensive care unit (ICU). We sought to determine the relationship between intensivist-to-patient ratios and mortality among ICU patients.: Methods: We ... ...

    Abstract Purpose: A high daily census may hinder the ability of physicians to deliver quality care in the intensive care unit (ICU). We sought to determine the relationship between intensivist-to-patient ratios and mortality among ICU patients.
    Methods: We performed a retrospective cohort study of intensivist-to-patient ratios in 29 ICUs in 10 hospitals in the United States from 2018 to 2020. We used meta-data from progress notes in the electronic health record to determine an intensivist-specific caseload for each ICU day. We then fit a multivariable proportional hazards model with time-varying covariates to estimate the relationship between the daily intensivist-to-patient ratio and ICU mortality at 28 days.
    Results: The final analysis included 51,656 patients, 210,698 patient days, and 248 intensivist physicians. The average caseload per day was 11.8 (standard deviation: 5.7). There was no association between the intensivist-to-patient ratio and mortality (hazard ratio for each additional patient: 0.987, 95% confidence interval: 0.968-1.007, p = 0.2). This relationship persisted when we defined the ratio as caseload over the sample-wide average (hazard ratio: 0.907, 95% confidence interval: 0.763-1.077, p = 0.26) and cumulative days with a caseload over the sample-wide average (hazard ratio: 0.991, 95% confidence interval: 0.966-1.018, p = 0.52). The relationship was not modified by the presence of physicians-in-training, nurse practitioners, and physician assistants (p value for interaction term: 0.14).
    Conclusions: Mortality for ICU patients appears resistant to high intensivist caseloads. These results may not generalize to ICUs organized differently than those in this sample, such as ICUs outside the United States.
    MeSH term(s) Humans ; United States ; Retrospective Studies ; Personnel Staffing and Scheduling ; Hospital Mortality ; Intensive Care Units ; Critical Care ; Physicians
    Language English
    Publishing date 2023-05-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0340-0964 ; 0342-4642 ; 0935-1701
    DOI 10.1007/s00134-023-07066-z
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  4. Article ; Online: Prevalence and risk factors for hepatocellular carcinoma in individuals with haemophilia in the era of direct-acting antiviral agents: A national inpatient sample study.

    Yang, Xi / Jeong, Kwonho / Yabes, Jonathan G / Ragni, Margaret V

    Haemophilia : the official journal of the World Federation of Hemophilia

    2022  Volume 28, Issue 5, Page(s) 769–775

    Abstract: Background: Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis C virus (HCV) infection. Among haemophilic (H) men, HCV is the leading cause of liver disease. Direct-acting antiviral agents (DAA) reduce HCV viral load, but impact ...

    Abstract Background: Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis C virus (HCV) infection. Among haemophilic (H) men, HCV is the leading cause of liver disease. Direct-acting antiviral agents (DAA) reduce HCV viral load, but impact on HCC is unknown.
    Methods: This was a retrospective study of adult H and nonhaemophilic (NH) male discharges, with and without HCC, identified by ICD-10 codes in the National Inpatient Sample (NIS) database, 2016-2018, with DAA availability. Analyses included discharge-level weights to reflect national estimates. Categorical variables were assessed by Rao-Scott chi-square and continuous variables by weighted simple linear regression. HCC correlates were determined by weighted multivariable logistic regression.
    Results: Among 7,674,969 adult male discharges, 3730 H (.04%) were identified in 2016-2018, of whom 10.06% had HCV and 1.07% had HCC, significantly higher than NH (1.22% and .27%, respectively) all P < .001. Annual HCC rates were similar during the 3-year period (2016-2018) in H and NH. Among H, HCC is associated with older age and higher rates of HCV, HBV, NASH, end-stage liver disease, and Charlson comorbidity (CCI), each P < .001. Among HCC, H were younger and more likely HIV+, each P < .001, but less likely alcoholic (P = .018) or hyperlipidaemic (P = .008) compared to NH. In multivariable regression, risk factors for HCC among H included NASH (OR 21.6), HCV (OR 3.96), CCI (OR1.54), all P < .001, while HIV and hyperlipidaemia were protective.
    Conclusion: From 2016 to 2018, HCC rates did not change significantly in haemophilia discharges. NASH, HCV, and CCI are significant risks for HCC in haemophilia during the DAA-era.
    MeSH term(s) Adult ; Antiviral Agents/therapeutic use ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/etiology ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/epidemiology ; Hemophilia A/complications ; Hemophilia A/drug therapy ; Hepatitis C, Chronic/complications ; Hepatitis C, Chronic/drug therapy ; Humans ; Inpatients ; Liver Neoplasms/complications ; Liver Neoplasms/etiology ; Male ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/drug therapy ; Non-alcoholic Fatty Liver Disease/pathology ; Prevalence ; Retrospective Studies ; Risk Factors
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2022-06-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1229713-6
    ISSN 1365-2516 ; 1351-8216 ; 1355-0691
    ISSN (online) 1365-2516
    ISSN 1351-8216 ; 1355-0691
    DOI 10.1111/hae.14607
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  5. Article ; Online: Telemedicine in urologic oncology care: Will telemedicine exacerbate disparities?

    Gul, Zeynep G / Sharbaugh, Danielle R / Ellimoottil, Chad / Rak, Kimberly J / Yabes, Jonathan G / Davies, Benjamin J / Jacobs, Bruce L

    Urologic oncology

    2024  Volume 42, Issue 2, Page(s) 28.e1–28.e7

    Abstract: Introduction: Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient ... ...

    Abstract Introduction: Disparities in prostate, bladder, and kidney cancer outcomes are associated with access to care. Telemedicine can improve access but may be underutilized by certain patient populations. Our objective was to determine if the patient populations who suffer worse oncologic outcomes are the same as those who are less likely to use telemedicine.
    Methods: Using an institutional database, we identified all prostate, bladder and kidney cancer encounters from March 14, 2020 to October 31, 2021 (n = 15,623; n = 4, 14; n = 3,830). Telemedicine was used in 13%, 8%, and 12% of these encounters, respectively. We performed random effects modeling analysis to examine patient and provider characteristics associated with telemedicine use. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported as measures of association.
    Results: Among prostate, bladder, and kidney cancer patients, Black patients had lower odds of a telemedicine encounter (OR 0.51, 95% CI 0.37-0.69; OR 0.22, 95% CI 0.07-0.70; OR 0.46, 95% CI 0.24-0.86), and patients residing in small and isolated small rural towns areas had higher odds of a telemedicine encounter (OR 1.44, 95% CI 1.09-1.91; OR 2.12, 95% CI 1.14-3.94; OR 1.89, 95% CI 1.12-3.19). Compared to providers in practice ≤5 years, providers in practice for 6 to 15 years had significantly higher odds of a telemedicine encounter for prostate and bladder cancer patients (OR 4.10, 95% CI 1.4511.58; OR 3.42, 95% CI 1.09-10.77).
    Conclusion: The lower rates of telemedicine use among Black patients could exacerbate pre-existing disparities in prostate, bladder, and kidney cancer outcomes.
    MeSH term(s) Male ; Humans ; Urinary Bladder ; Prostate ; Carcinoma, Renal Cell ; Kidney Neoplasms ; Telemedicine
    Language English
    Publishing date 2024-01-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1336505-8
    ISSN 1873-2496 ; 1078-1439
    ISSN (online) 1873-2496
    ISSN 1078-1439
    DOI 10.1016/j.urolonc.2023.10.002
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  6. Article ; Online: Predictors of persistent opioid use in bladder cancer patients undergoing radical cystectomy: A SEER-Medicare analysis.

    Staniorski, Christopher J / Yu, Michelle / Sharbaugh, Danielle / Stencel, Michael G / Myrga, John M / Davies, Benjamin J / Yabes, Jonathan G / Jacobs, Bruce

    Urologic oncology

    2024  

    Abstract: Purpose: To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients.: Methods: Patients undergoing cystectomy between July 2007 and December ... ...

    Abstract Purpose: To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients.
    Methods: Patients undergoing cystectomy between July 2007 and December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy using Medicare Part D data. Multivariable analyses were used to identify predictors of the primary outcomes: persistent opioid use (prescription 3-6 months after surgery) and postoperative opioid prescriptions (within 30 days of surgery). Secondary outcomes included physician prescribing practices and rates of persistent opioid use in their patient cohorts.
    Results: A total of 1,774 patients were included; 29% had prior opioid exposure. Compared to opioid-naïve patients, non-opioid naïve patients were more frequently younger, Black, and living in less educated communities. The percentage of persistent postoperative use was 10% overall and 24% in non-opioid naïve patients. Adjusting for patient factors, opioid naïve individuals were less likely to develop persistent use (OR 0.23) while a 50-unit increase in oral morphine equivalent per day prescribed following surgery nearly doubled the likelihood of persistent use (OR 1.98). Practice factors such as hospital size, teaching affiliation, and hospital ownership failed to predict persistent use. 29% of patients filled an opioid prescription postoperatively. Opioid naïve patients (OR 0.13) and those cared for at government hospitals (OR 0.59) were less likely to fill an opioid script along with those residing in the Northeast. Variability between physicians was seen in prescribing practices and rates of persistent use.
    Conclusions: Non-opioid naïve patients have higher rates of post-operative opioid prescription than opioid-naïve patients. Physician prescribing practices play a role in persistent use, as initial prescription amount predicts persistent use even in non-opioid naïve patients. Significant physician variation in both prescribing practices and rates of persistent use suggest a role for standardizing practices.
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1336505-8
    ISSN 1873-2496 ; 1078-1439
    ISSN (online) 1873-2496
    ISSN 1078-1439
    DOI 10.1016/j.urolonc.2024.03.010
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  7. Article ; Online: Issues in Designing and Interpreting Small Clinical Trials.

    Althouse, Andrew D / Yabes, Jonathan G / Abebe, Kaleab Z

    The Canadian journal of cardiology

    2021  Volume 37, Issue 9, Page(s) 1332–1339

    Abstract: The randomised controlled trial (RCT) is a powerful approach for testing the effectiveness of various clinical interventions. Cardiology often benefits from large RCTs, which may be used to inform practice decisions ranging from primary prevention to ... ...

    Abstract The randomised controlled trial (RCT) is a powerful approach for testing the effectiveness of various clinical interventions. Cardiology often benefits from large RCTs, which may be used to inform practice decisions ranging from primary prevention to advanced cardiac disease and/or acute cardiac care. RCTs in cardiology often need to be quite large to test for meaningful effects on clinical outcomes, because effect sizes are typically modest and clinical outcomes may take several years to occur after treatment initiation. However, a variety of small clinical trials are also carried out in the biomedical research enterprise; these are often difficult to design and interpret, because the objectives and needs of small clinical trials are quite variable. Some are pilot trials that may be used to refine processes or as part of the planning in advance of a larger trial designed to test therapeutic efficacy. Some are first-in-human or proof-of-concept studies that, also, will eventually be followed by one or more larger trials to test therapeutic efficacy. Some are intended to be stand-alone trials that are small for other reasons. In this paper, we explore some key issues related to design and interpretation of small clinical trials in cardiology. We broadly classify small trials into 4 types: 1) pilot trials, 2) early-stage or proof-of-concept trials, 3) rare diseases or difficult-to-recruit populations, and 4) underpowered trials. For each, we describe the appropriate objectives, analysis, and interpretation.
    MeSH term(s) Clinical Trials as Topic ; Data Interpretation, Statistical ; Humans ; Pilot Projects ; Proof of Concept Study ; Rare Diseases ; Research Design ; Sample Size
    Language English
    Publishing date 2021-03-26
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 632813-1
    ISSN 1916-7075 ; 0828-282X
    ISSN (online) 1916-7075
    ISSN 0828-282X
    DOI 10.1016/j.cjca.2021.03.013
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  8. Article ; Online: Factor VIII concentrate dosing with lean body mass, ideal body weight and total body weight in overweight and obesity: A randomized, controlled, open-label, 3 × 3 crossover trial.

    Seaman, Craig D / Yabes, Jonathan G / Lalama, Christina M / Ragni, Margaret V

    Haemophilia : the official journal of the World Federation of Hemophilia

    2021  Volume 27, Issue 3, Page(s) 351–357

    Abstract: Introduction: Obesity alters the pharmacokinetic (PK) properties of drugs making it difficult to determine the appropriate dose when administering weight-based medications. Alternative descriptors of body weight, such as lean body mass (LBM) and ideal ... ...

    Abstract Introduction: Obesity alters the pharmacokinetic (PK) properties of drugs making it difficult to determine the appropriate dose when administering weight-based medications. Alternative descriptors of body weight, such as lean body mass (LBM) and ideal body weight (IBW), are sometimes used in these situations.
    Methods: We performed a single-centre, randomized, controlled, open-label, 3 × 3 crossover trial to determine whether recombinant factor VIII (rFVIII) dosing based on LBM and IBW achieves a targeted FVIII recovery with better precision than based on total body weight (TBW) in overweight and obese, adult males with haemophilia A. Participants were randomized to 1 of 6 possible FVIII concentrate dosing sequence scenarios (TBW, LBM and IBW). Recombinant FVIII was administered on 3 separate weeks following a washout period of at least 72 hours.
    Results: A total of 19 participants were randomized and completed the study. FVIII recovery was lower at 30 minutes post-rFVIII infusion in LBM vs TBW and IBW vs TBW-based dosing, mean difference -0.38 (95% CI: -0.56, -0.20) and -0.28 (95% CI: -0.47, -0.10) IU/dL per IU/kg, respectively. In LBM vs TBW and IBW vs TBW-based dosing, there was a non-significant increase in the proportion of participants with a targeted FVIII recovery of 2.00 ± 0.20 IU/dl per IU/kg, OR = 1.93 (95% CI: 0.44, 8.55) and OR = 3.65 (0.80, 16.72), respectively.
    Discussion: Based on our study's findings, overweight and obese patients with haemophilia A may benefit from an individualized PK analysis using LBM and IBW to determine the most accurate, and potentially cost-effective, method of achieving targeted FVIII recovery.
    MeSH term(s) Adult ; Body Weight ; Cross-Over Studies ; Factor VIII ; Hemophilia A/drug therapy ; Humans ; Ideal Body Weight ; Male ; Obesity/complications ; Overweight/complications
    Chemical Substances Factor VIII (9001-27-8)
    Language English
    Publishing date 2021-03-22
    Publishing country England
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 1229713-6
    ISSN 1365-2516 ; 1351-8216 ; 1355-0691
    ISSN (online) 1365-2516
    ISSN 1351-8216 ; 1355-0691
    DOI 10.1111/hae.14285
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  9. Article ; Online: Telemedicine Visits to Children During the Pandemic: Practice-Based Telemedicine Versus Telemedicine-Only Providers.

    Ray, Kristin N / Wittman, Samuel R / Yabes, Jonathan G / Sabik, Lindsay M / Hoberman, Alejandro / Mehrotra, Ateev

    Academic pediatrics

    2022  Volume 23, Issue 2, Page(s) 265–270

    Abstract: Objective: In March 2020, regulatory and payment changes allowed "brick and mortar" pediatric practices to offer practice-based telemedicine for the first time, joining direct-to-consumer (DTC) telemedicine vendors in the ability to offer visits for ... ...

    Abstract Objective: In March 2020, regulatory and payment changes allowed "brick and mortar" pediatric practices to offer practice-based telemedicine for the first time, joining direct-to-consumer (DTC) telemedicine vendors in the ability to offer visits for common acute pediatric concerns via telemedicine. We sought to characterize the relative contribution of practice-based telemedicine versus commercial DTC telemedicine models in provision of children's telemedicine from 2018 through 2021.
    Methods: Using January 2018 to September 2021 data from Optum's de-identified Clinformatics® Data Mart Database, we identified telemedicine visits by children ≤17, excluding preventive visits and visits to specialists, emergency departments, and urgent care. Among included visits, we defined "telemedicine-only" providers as those with ≥80% of visits via telemedicine and practice-based telemedicine providers as those with ≤50% of visits via telemedicine. We then described the telemedicine visit volume and diagnoses for these categories overall and per 1000 children per month.
    Results: From January 2018 to February 2020, telemedicine-only providers accounted for 57,815 telemedicine visits (90.8%), while practice-based telemedicine accounted for 4192 telemedicine visits (6.6%). From March 2020 to September 2021, telemedicine-only providers accounted for 38,282 telemedicine visits (6.1%), while practice-based telemedicine accounted for 555,125 telemedicine visits (88.2%). Per month, telemedicine visits to practice-based telemedicine providers increased from pre-pandemic to pandemic periods (0.1 vs 12.9 visits per 1000 children/month), while telemedicine visits to telemedicine-only providers occurred at a similar rate from pre-pandemic to pandemic periods (0.92 vs 0.96 visits per 1000 children/month).
    Conclusions: We observed a large increase in telemedicine visits during the pandemic, with the growth in visits exclusively occurring among visits to practice-based telemedicine providers as opposed to telemedicine-only providers.
    MeSH term(s) Humans ; Child ; COVID-19 ; Pandemics/prevention & control ; Telemedicine ; Ambulatory Care ; Databases, Factual
    Language English
    Publishing date 2022-05-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2483385-X
    ISSN 1876-2867 ; 1876-2859
    ISSN (online) 1876-2867
    ISSN 1876-2859
    DOI 10.1016/j.acap.2022.05.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Initial opioid prescribing and subsequent opioid use after dental procedures among opioid-naive patients in Pennsylvania Medicaid, 2012 through 2017.

    Khouja, Tumader / Moore, Paul A / Yabes, Jonathan G / Weyant, Robert J / Donohue, Julie M

    Journal of the American Dental Association (1939)

    2022  Volume 153, Issue 6, Page(s) 511–520.e13

    Abstract: Background: Little is known about how opioid prescribing differs for dental procedures with low, moderate, or high pain or whether that prescribing is associated with continued opioid use.: Methods: The authors used Pennsylvania Medicaid claims data ... ...

    Abstract Background: Little is known about how opioid prescribing differs for dental procedures with low, moderate, or high pain or whether that prescribing is associated with continued opioid use.
    Methods: The authors used Pennsylvania Medicaid claims data from 2012 through 2017. They categorized dental procedures into 3 groups of pain (low, moderate, high). Using multivariable logistic regression models with random intercept, the authors estimated the probability of receiving an initial opioid prescription within 7 days before and 3 days after a dental procedure associated with the pain categories and assessed subsequent short- and long-term (4-90 days and 91-365 days, respectively) opioid use.
    Results: The authors identified 1,345,360 index dental procedures (among 912,121 enrollees), of which 67.6% were categorized as low pain, 1.6% as moderate pain, and 30.9% as high pain. Predicted probability of an initial opioid prescription was 2.4% (95% CI, 2.4% to 2.5%) for low-pain, 8.3% (95% CI, 7.9% to 8.6%) for moderate-pain, and 31.8% (95% CI, 31.6% to 31.9%) for high-pain procedures. Predicted probabilities for short-term use for those who did not fill versus those who did fill an opioid prescription were 0.9% (95% CI, 0.9% to 1.0%) versus 25.0% (95% CI, 24.5% to 25.6%) for the low-pain, 1.6% (95% CI, 1.4% to 1.8%) versus 16.6% (95% CI, 14.9% to 18.4%) for moderate-pain, and 2.9% (95% CI, 2.8% to 3.0%) versus 13.5% (95% CI, 13.3% to 13.7%) for the high-pain groups.
    Conclusions: Although enrollees undergoing high-pain dental procedures were more likely to fill an initial opioid prescription than their counterparts with low- to moderate-pain procedures, the relative risk of experiencing sustained opioid use (4-90 days postprocedure) was highest in the low-pain group.
    Practical implications: More attention should be paid to reducing opioid prescribing for dental procedures with low pain risk.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Dentistry ; Humans ; Medicaid ; Pain ; Pain, Postoperative/drug therapy ; Pennsylvania/epidemiology ; Practice Patterns, Dentists' ; Practice Patterns, Physicians' ; Retrospective Studies ; United States/epidemiology
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-02-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 220622-5
    ISSN 1943-4723 ; 0002-8177 ; 1048-6364
    ISSN (online) 1943-4723
    ISSN 0002-8177 ; 1048-6364
    DOI 10.1016/j.adaj.2021.11.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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