Amidst the opioid epidemic in the U.S., provider-level interventions such as prescription drug monitoring programs and naloxone access laws, in addition to influence of peers in opioid prescribing highlight the role of healthcare providers. The first objective of this dissertation was to identify key players and network positions of opioid initiators among patients initiated on opioids. The second objective was to identify positions of providers involved with high-risk and chronic opioid use and naloxone prescribing. The third objective was to identify positions of providers prescribing opioids in patients with chronic pain.
Patients and providers were identified using Commercial and Medicaid claims from Arkansas All-Payer Claims-Database between 2013–2018. A social network comprising provider as nodes and referrals as edges was constructed. For objective 1, the network was constructed over 180 days prior to incident opioid use, for objectives 2 and 3 over 360 days after incident opioid use and chronic pain diagnosis respectively. Measures of network centrality such as indegree (referrals obtained), eigen and clustering (neighbor importance), betweenness (involvement) and closeness (reach) were assessed. Outcomes included provider influence determined by network measures, provider prescribing characteristics (any opioid, chronic opioid, naloxone). Key measures included provider network centralities and provider demographics and characteristics (age, gender, specialty, region). Generalized linear mixed effect regression models were used for statistical analyses.
Overall, it was found that key providers were middle-aged to elderly, males and primary care providers (PCPs). Specialists were found to be influential in chronic pain patients, in addition to PCPs. In terms of prescribing characteristics, providers with higher centralities were more likely to be initiate patients on opioids and to be chronic opioid prescribers and naloxone prescribers. However, the rate of opioid prescribing was found to be associated with lower centralities except for closeness.
This study highlights provider characteristics which can be used as levers to influence behavior of physicians in a network. Findings such as PCPs having higher influence and reach, higher influence of opioid and naloxone providers and lower influence of high-volume opioid prescribers can be used to direct interventions to reduce risky opioid prescribing and greater awareness about naloxone prescribing.
|Advisor:||Martin, Bradley C.|
|Commitee:||Painter, Jacob T., Li, Chenghui, Bona, Jonathan P., Nookaew, Intawat|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 82/7(E), Dissertation Abstracts International|
|Subjects:||Pharmaceutical sciences, Health sciences, Health care management|
|Keywords:||All Payer Claims Database, Arkansas, Centrality, Opioids, Pain, Social network analysis|
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