Aaron E. Carroll's Blog, page 7

An In-Depth Look at America’s Opioid Crisis

This compilation is a deep dive on the opioid crisis, thanks in part to funding by the NIHCM. Explore the history of opioids, the science of opioids, and learn about how and why attitudes and US policy regarding addiction treatment and opioid control need to change.

 



 

0:00 Intro

0:22 A Brief History of Opioids

8:13 Opioid Science

16:14 Opioid Addiction Treatment

22:26 The Opioid Crisis Continues

31:34 Deaths of Despair

37:49 What Can We Do About Opioids?

 

Be sure to check out our podcast!    • Podcast   Other Healthcare Triage Links: 1. Support the channel on Patreon: http://vid.io/xqXr 2. Check out our Facebook page: http://goo.gl/LnOq5z 3. We still have merchandise available at http://www.hctmerch.com 4. Aaron’s book “The Bad Food Bible: How and Why to Eat Sinfully” is available wherever books are sold, such as Amazon: http://amzn.to/2hGvhKw Credits: Aaron Carroll — Writer Tiffany Doherty — Writer and Script Editor John Green — Executive Producer Stan Muller — Director, Producer Mark Olsen – Art Director, Producer

The post An In-Depth Look at America’s Opioid Crisis first appeared on The Incidental Economist.

Racial and Ethnic Disparities in Excess Mortality for US Veterans during the COVID-19 Pandemic

Structural racism in the United States (US) has long contributed to health disparities in minoritized communities through reduced health care access and economic inequities. The COVID-19 pandemic exacerbated these issues, with racial and ethnic minorities experiencing higher rates of severe illness, job loss, and poor living conditions.

The Veterans Health Administration (VHA), serving over nine million Veterans, is becoming more ethnically and racially diverse. In addition, VHA enrollees tend to have a higher number of comorbidities and higher risk for severe COVID-19 illness compared to the general US population. Previous work found that minoritized Veterans were disproportionately affected by excess mortality during the COVID-19 pandemic, but that work did not account for Veterans’ underlying health status such as group-level differences in comorbidity burden.

New Research:

In the study, “Racial and ethnic disparities in excess mortality among US Veterans during the COVID-19 pandemic,” researchers at the Partnered Evidence-based Policy Resource Center (PEPReC) examined how the pandemic may have disproportionately affected Veterans from different racial and ethnic backgrounds. To understand the impact on minoritized communities, PEPReC researchers expanded on existing work, using a longer time period and a previously validated approach to identify excess mortality attributable to the COVID-19 pandemic. Excess mortality refers to the number of deaths for a specific time (i.e., pandemic) that is above what would be expected based on historical averages.

Methods:

PEPReC researchers queried nationwide data from VHA’s Corporate Data Warehouse for Veteran demographics (e.g., race/ethnicity, age) and other characteristics that were previously associated with mortality risk (e.g., service-connected disabilities, major comorbidities). A validated mortality risk prediction model was leveraged to estimate the expected mortality among Veterans, using five years of pre-pandemic data and controlling for disease burden. Once established, the model was then used to generate predicted Veteran mortality for the pandemic period (March to December 2020) specifically, along with estimating excess mortality for each race/ethnicity group.

Findings:

To populate the mortality risk prediction model, the researchers analyzed data from about 9.3 million unique Veterans seeking care at VHA between 2016 and 2020, excluding those with missing race/ethnicity or county information.

For the pandemic period, March to December 2020, they observed monthly enrollment of 7.8 million Veterans and 261,523 Veteran deaths. Overall, Veterans’ mortality rates were 16% above normal during the pandemic period, equating to 42,348 excess deaths.

Excess mortality rates increased significantly for particular racial and ethnic groups as well. Native American, Black, and Hispanic Veterans faced significantly higher excess mortality rates (40%, 32%, and 26%, respectively), compared to the lowest calculated excess mortality rate in non-Hispanic White Veterans (17%). However, these disparities in VHA were smaller than what is seen in the general US population.

Conclusion:

The study’s findings reflect the broader societal inequities exacerbated by the pandemic. To address these issues in VHA, it is essential to expand health care services in underserved areas and increase funding for Veteran-specific programs that improve access to care. Expanding VHA’s telehealth services, which have successfully reached minority Veterans in remote or rural areas, is one effective strategy to ensure timely medical attention.

Implementing targeted interventions, such as community outreach and culturally competent care, could also help reduce disparities and improve health outcomes for minority Veterans. Provider training programs on cultural competency have been shown to enhance patient-provider interactions and care quality.

During the COVID-19 pandemic, VHA observed racial and ethnic disparities in excess mortality, with minoritized Veterans dying at higher rates compared to White Veterans. While progress has been made in addressing structural racism within VHA, further improvements in care quality, delivery, and access are needed, especially for communities of color.

 

The post Racial and Ethnic Disparities in Excess Mortality for US Veterans during the COVID-19 Pandemic first appeared on The Incidental Economist.

Elder Abuse and Mental Health: Victims, Perpetrators, and Potential for Change

As the population of older adults in America swells in the coming decades, the risk of elder abuse increases. While elder abuse can manifest in obvious ways, there are many forms of elder abuse that are discrete, and all impact older adults’ mental health. Importantly, perpetrators of elder abuse deal with mental health challenges, too. As a result, addressing underlying mental health concerns for both older adults and perpetrators of elder abuse is of high priority. I wrote about this in Behavioral Health News today:

“The COVID-19 pandemic produced a perfect storm for elder abuse that reverberates today, as both older adults and perpetrators experienced social isolation, stress, and health problems. One survey of community-based caregivers shows that, post-COVID, they are drinking more alcohol, feeling significantly more socially isolated and lonely, and are more worried about their finances than before the pandemic (Makaroun et al., 2021).”

Read the whole piece here, beginning on page 27.

The post Elder Abuse and Mental Health: Victims, Perpetrators, and Potential for Change first appeared on The Incidental Economist.

Medical Training Programs Impact on VHA Physician Workforce Recruitment, Productivity, and Turnover

Health systems across the country are grappling with how to recruit and retain health care professionals. Student loan repayment programs and sign-on bonuses are now commonplace incentives to attract top talent, especially for high-need specialties and locations. Addressing these challenges is critical to the Veterans Health Administration’s (VHA) mission to provide care to our nation’s Veterans.

VHA leverages its extensive health education and training program to prepare physicians to enter the field in service of this mission. Interestingly, a recent evaluation by the Partnered Evidence-based Policy Resource Center (PEPReC) found that increasing the size of medical training programs at a VHA medical center was associated with a small decrease in facility productivity and a small increase in staff turnover. However, increasing the size of the programs was also associated with a decrease in the time needed to fill vacant positions.

PEPReC published a brief detailing the impact of VHA physician training programs on facility-level productivity, turnover rates, and time to fill vacancies. For more, read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Medical Training Programs Impact on VHA Physician Workforce Recruitment, Productivity, and Turnover first appeared on The Incidental Economist.

Will the sale of two RI hospitals make health care better in the state?

Our Lady of Fatima Hospital and Roger Williams Medical Center in Rhode Island are not doing well but their proposed sale to The Centurion Foundation is less than straight forward. The Attorney General and Department of Health recently approved the sale, but not without dozens of stipulations. Time will tell if the sale goes through and, if it does, if it’s good for Rhode Islanders. I wrote about this in The Providence Journal earlier this week.

But the sale of Our Lady of Fatima Hospital and Roger Williams Medical Center doesn’t fit into the nice, clean “mergers and acquisitions are bad” box. It’s neither an excellent decision nor a terrible decision for Rhode Island. What it is is complicated.

Read the full piece here.

Research for this article was supported by Arnold Ventures.

The post Will the sale of two RI hospitals make health care better in the state? first appeared on The Incidental Economist.

Clinic Efficiency: Improving Access to Care Within Resource Constraints

The Veterans Health Administration (VHA), operating within the constraints of a congressionally allocated budget, must focus on improving clinic efficiency as a way to meet the growing Veteran demand for care. Clinic efficiency, defined as the productivity or work rate of providers, is an important predictor of clinic operations and outcomes. Thus, optimizing aspects of VHA clinic operations can help ensure that Veterans receive consistent access to both preventative care and treatment.

Recognizing the need, the Partnered Evidence-based Policy Resource Center (PEPReC) published a policy brief that delves into the significance of clinic efficiency. This brief also highlights PEPReC’s pilot program aimed at improving clinic efficiency. By collaborating with various VHA facility leaders at select facilities, the pilot program focused on facilitating transparency by reporting and sharing validated data. Read the full brief here.

PEPReC, within the Veterans Health Administration and funded in large part by the Quality Enhancement Research Initiative (QUERI), is a team of health economists, health services and public health researchers, statistical programmers, and policy analysts who engage policymakers to improve Veterans’ lives through evidence-driven innovations using advanced quantitative methods.

The post Clinic Efficiency: Improving Access to Care Within Resource Constraints first appeared on The Incidental Economist.

Elections Are Bad for Your Health, Research Suggests

With the 2024 presidential elections in full swing, and a debate between President Joe Biden and former President Donald Trump scheduled for next week, we need to talk about voter health. Politics can be stressful, and research shows it can actually also harm your health. Some of us consume political content everyday, and terms like post-election stress disorder have been coined to describe common experiences of mental, emotional, and physical discomfort after a critical election. I wrote more about this in Teen Vogue with some tips on how to mitigate election-related health consequences, including:

Limiting media consumption, especially political contentSetting boundaries on where and when you have political discussionsEstablishing policy to limit sensitive discussions in the workplaceGetting involved with issues that matter to you

Read the whole piece here.

The post Elections Are Bad for Your Health, Research Suggests first appeared on The Incidental Economist.

Deadline Extended: HSR Call for Abstracts on the Role of Health Services Research in Advances in Cancer Prevention and Control

Cross-posted from the Health Services Research website.

Sponsored by: Department of Public Health Sciences, University of Virginia School of Medicine
Submission deadline for abstracts: Monday 17 July 2024

Health Services Research (HSR) and the Department of Public Health Sciences, University of Virginia School of Medicine are partnering to publish a Special Issue on The Role of Health Services Research in Cancer Prevention and Control. The special issue will be edited by Kevin Schulman, MD, Roger Anderson, PhD, Xin Hu, PhD, and Asal Pilehvari, PhD.

Paradigm shifts in cancer screening such as mammography, colonoscopy, and Pap smears have been pivotal in detecting cancers at earlier and more treatable stages. Treatments including targeted therapies, immunotherapies, and precision medicine have prolonged disease-free intervals, improved overall survival, and enhanced quality of life for survivors. Interventions in the delivery and quality of palliative care and hospice utilization have improved the end-of-life experience. Health services research has contributed significantly to evaluating the effectiveness, accessibility, and implementation strategies of these screening programs, treatments, and interventions, guiding their integration into clinical practice.

Nonetheless, challenges persist in ensuring equitable access to high-quality cancer care for all. Disparities in cancer outcomes based on factors including socioeconomic status, sex, gender identification, race, ethnicity, disability, comoribidities, care delivery system, health policy, and geographical location remain a concern. Addressing these disparities and further improving cancer prevention and control strategies requires a comprehensive application of health services research.

Health services research can contribute to understanding how integrating innovative approaches of technology such as artificial intelligence (AI), predictive analytics, big data analytics, and evidence synthesis methodologies can improve informed decision-making across the cancer care continuum. Health services research can also inform policy innovations that promote access to care, and patient-centered care approaches. All present opportunities to further enhance cancer prevention and control and improve patient outcomes.

This special issue will include empirical studies that illuminate the application of health services research throughout the cancer care continuum, from prevention and early detection to treatment, survivorship, and end-of-life care. Examples of topic areas of interest include but are not limited to:

Evaluation of cancer care quality indicators, cancer care utilization and economic outcomes, and/or organizational structures or designs associated with efficiency and effectiveness of cancer care delivery.Evaluation of the use of cutting-edge technologies, including AI and machine learning:to evaluate and/or quantify cancer care quality, utilization, and outcomes; oras a clinical application to improve personalized treatment decision, cancer care quality and utilization in real-world-applications, such as risk stratification, pattern recognition, or improved diagnostic accuracy.Generation of data-driven recommendations to address the access, cost or quality of cancer care for key stakeholders across the cancer control continuum, from prevention to end-of-life care, including but not limited to insurance companies, professional societies, health care providers, governments, patients and caregivers.

HSR is issuing a call for abstracts to invite paper submissions for this special issue. The deadline for initial submission of abstracts is 17 July 2024.  Abstracts may not exceed 300 words and must be formatted as indicated in the HSR Author Instructions (Section 2.4.2.2, keywords not necessary).

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include:

Quality, rigor, and originalityRelevance to the special issue themeClarity of writing and presentation.

Authors of abstracts that most closely match the criteria will be invited in August to submit full manuscripts in November 2024.

Invited manuscripts must follow the Author Instructions and undergo the same HSR peer review process as regular issue manuscripts. However, due to the strict timeline for publishing the special issue, the review and revision process will follow an expedited timeline. Authors must be prompt in returning revisions. Invited articles will be published online on acceptance. Some accepted articles might not be selected for the special issue but will be published in a regular issue.

The expected publication date for the special issue is March 2026.

To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “Special Issue HSR in Cancer” in the email subject line.

Key dates for authors

Submission deadline for abstracts: 17 July 2024

Full manuscript invitation: 12 August 2024

Full manuscript deadline: 15 November 2024

Special issue publication date: March 2026

Questions? Please email Kelly Teagle at hsr@aha.org.

The post Deadline Extended: HSR Call for Abstracts on the Role of Health Services Research in Advances in Cancer Prevention and Control first appeared on The Incidental Economist.

Potential Inequities in Accessing Medicare Counseling

Navigating health insurance options can be difficult, and Medicare is no exception. The State Health Insurance Assistance Program (SHIP) was created under the Omnibus Budget Reconciliation Act of 1990 to help Medicare beneficiaries understand their coverage, but it’s been unclear who the program actually helps.

SHIP is a federal program that provides funding to states to counsel Medicare beneficiaries on coverage choices, eligibility, and costs. It’s overseen by the Administration for Community Living (ACL), which provides grants to states that are then often distributed to local organizations providing services through paid and volunteer counselors.

The ACL produces public reports that focus on state-level contact metrics within SHIP but do not include more granular information. To date, we haven’t known whether SHIP sites are located efficiently (i.e., in areas with high concentrations of Medicare beneficiaries) or equitably serve both low- and high-income beneficiaries. This data would help identify potential unmet needs for services, an effort that is required by the Medicare Improvements for Patients and Providers Act.

New Research

In a study published in the American Journal of Managed Care, evaluators from Boston University School of Public Health identified areas where in-person SHIP service expansion might be beneficial.

Using 27 state directories of SHIP sites (totaling over 1,500 sites) and population socioeconomic conditions, authors examined whether SHIP sites were disproportionately located in higher-income communities. SHIP sites were mapped to Zip Code Tabulation Areas (ZCTA), which allow for geographic analysis of zip codes.

To understand the characteristics of areas where SHIP counseling was more or less likely to be available, four types of geographical areas were compared:

ZCTAs with SHIP services;ZCTAs without SHIP services but located in a county with SHIP services;ZCTAs located in a county without SHIP services but where an adjacent county had SHIP services; andZCTAs located in a county without SHIP services and where no adjacent counties had SHIP services.

Linear regressions and t-tests were then used to evaluate whether SHIP counseling sites were disproportionately located in communities with higher incomes and/or fewer Medicare beneficiaries.

Findings

More than half of the ZCTAs included (63%) had a SHIP site within the ZCTA or surrounding county, a quarter (24%) only had a SHIP site in an adjacent county, and the remaining 13% did not have a SHIP within or in an adjacent county.

The authors also found that a disproportionate number of Medicare-aged eligible adults live in localities without a nearby SHIP site. Median household income and educational attainment were also lower in areas without in-person SHIP services.

Access to SHIP services may be affected by the availability of volunteer counselors, non-English services, education, and transportation options. This is especially true for beneficiaries living in low-income neighborhoods, which are more likely to be in rural areas and have more non-English speakers.

These findings only indicate associations between SHIP sites and the areas within which they’re located. The size of ZCTAs and counties also vary, so a SHIP site could be in the same county as an individual but still require a long drive to reach these services.

Conclusion

This study suggests that there may be inequities in where in-person SHIP services are located and potential unmet needs for service expansion. Although telephone counseling is always an option, access to in-person services is important for dually eligible individuals with complex health needs, those with hearing loss, limited English proficiency, or who need a caregiver or companion to help understand the information provided.

The post Potential Inequities in Accessing Medicare Counseling first appeared on The Incidental Economist.

The Drug Shortage Putting Newborns at Risk

For some women, a simple shot during pregnancy and then right after labor can prevent a huge amount of suffering for both parents and future children. So what happens when there’s a shortage that prevents that shot from happening?

 



The post The Drug Shortage Putting Newborns at Risk first appeared on The Incidental Economist.