9 results on '"Marc R. Larochelle"'
Search Results
2. Association of Early Opioid Withdrawal Treatment Strategy and Patient-Directed Discharge Among Hospitalized Patients with Opioid Use Disorder
- Author
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Mohammad Alrawashdeh, Chanu Rhee, Michael Klompas, Marc R. Larochelle, Russell E. Poland, Jeffrey S. Guy, and Simeon D. Kimmel
- Subjects
Internal Medicine - Published
- 2023
3. Do Urine Drug Tests Reveal Substance Misuse Among Patients Prescribed Opioids for Chronic Pain?
- Author
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Jeffrey H. Samet, Sarah Kosakowski, Doug L. Gourlay, Jane M. Liebschutz, Marc R. Larochelle, Ricardo Cruz, Ziming Xuan, Shapei Yan, Erin E. Krebs, Daniel P. Alford, and Karen E. Lasser
- Subjects
Male ,Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Chronic pain ,Retrospective cohort study ,Odds ratio ,Urine ,Opioid-Related Disorders ,medicine.disease ,Mental health ,Confidence interval ,Analgesics, Opioid ,Substance Abuse Detection ,Internal medicine ,Intervention (counseling) ,Internal Medicine ,medicine ,Humans ,Female ,Chronic Pain ,business ,Retrospective Studies ,media_common - Abstract
Urine drug testing (UDT) is a recommended risk mitigation strategy for patients prescribed opioids for chronic pain, but evidence that UDT supports identification of substance misuse is limited. Identify the prevalence of UDT results that may identify substance misuse, including diversion, among patients prescribed opioids for chronic pain. Retrospective cohort study. Patients (n=638) receiving opioids for chronic pain who had one or more UDTs, examining up to eight substances per sample, during a one 1-year period. Experts adjudicated the clinical concern that UDT results suggest substance misuse or diversion as not concerning, uncertain, or concerning. Of 638 patients, 48% were female and 49% were over age 55 years. Patients had a median of three UDTs during the intervention year. We identified 37% of patients (235/638) with ≥1 concerning UDT and a further 35% (222/638) having ≥1 uncertain UDT. We found concerning UDTs due to non-detection of a prescribed substance in 24% (156/638) of patients and detection of a non-prescribed substance in 23% (147/638). Compared to patients over 65 years, those aged 18–34 years were more likely to have concerning UDT results with an adjusted odds ratio (AOR) of 4.8 (95% confidence interval [CI] 1.9–12.5). Patients with mental health diagnoses (AOR 1.6 [95% CI 1.1–2.3]) and substance use diagnoses (AOR 2.3 [95% CI 1.5–3.7]) were more likely to have a concerning UDT result. Expert adjudication of UDT results identified clinical concern for substance misuse in 37% of patients receiving opioids for chronic pain. Further research is needed to determine if UDTs impact clinical practice or patient-related outcomes.
- Published
- 2021
4. Prior Incarceration Is Associated with Poor Mental Health at Midlife: Findings from a National Longitudinal Cohort Study
- Author
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Benjamin J, Bovell-Ammon, Aaron D, Fox, and Marc R, LaRochelle
- Abstract
People with mental illnesses and people living in poverty have higher rates of incarceration than others, but relatively little is known about the long-term impact that incarceration has on an individual's mental health later in life.To evaluate prior incarceration's association with mental health at midlife.Retrospective cohort study PARTICIPANTS: Participants from the National Longitudinal Survey of Youth 1979 (NLSY79)-a nationally representative age cohort of individuals 15 to 22 years of age in 1979-who remained in follow-up through age 50.Midlife mental health outcomes were measured as part of a health module administered once participants reached 50 years of age (2008-2019): any mental health history, any depression history, past-year depression, severity of depression symptoms in the past 7 days (Center for Epidemiologic Studies Depression [CES-D] scale), and mental health-related quality of life in the past 4 weeks (SF-12 Mental Component Score [MCS]). The main exposure was any incarceration prior to age 50.Among 7889 participants included in our sample, 577 (5.4%) experienced at least one incarceration prior to age 50. Prior incarceration was associated with a greater likelihood of having any mental health history (predicted probability 27.0% vs. 16.6%; adjusted odds ratio [aOR] 1.9 [95%CI: 1.4, 2.5]), any history of depression (22.0% vs. 13.3%; aOR 1.8 [95%CI: 1.3, 2.5]), past-year depression (16.9% vs. 8.6%; aOR 2.2 [95%CI: 1.5, 3.0]), and high CES-D score (21.1% vs. 15.4%; aOR 1.5 [95%CI: 1.1, 2.0]) and with a lower (worse) SF-12 MCS (-2.1 points [95%CI: -3.3, -0.9]; standardized mean difference -0.24 [95%CI: -0.37, -0.10]) at age 50, when adjusting for early-life demographic, socioeconomic, and behavioral factors.Prior incarceration was associated with worse mental health at age 50 across five measured outcomes. Incarceration is a key social-structural driver of poor mental health.
- Published
- 2022
5. Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: a Cohort Study
- Author
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Maryam M. Asgari, Katherine A. Su, Matthew Callahan, J. Frank Wharam, Marc R. Larochelle, Yuhree Kim, Fang Zhang, and David E. Fisher
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Adult ,medicine.medical_specialty ,Adolescent ,01 natural sciences ,vitamin D deficiency ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Internal Medicine ,Vitamin D and neurology ,Humans ,Medicine ,030212 general & internal medicine ,Vitamin D ,0101 mathematics ,Original Research ,business.industry ,010102 general mathematics ,Chronic pain ,Opioid use disorder ,Perioperative ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Opioid ,Cohort ,business ,Cohort study ,medicine.drug - Abstract
IMPORTANCE: Vitamin D deficiency is associated with chronic pain syndromes and higher opioid use among cancer patients, but its association with opioid use among opioid-naïve subjects following a major surgical procedure with acute pain has not been explored. OBJECTIVE: To determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels, opioid use, and opioid use disorder. METHODS: We identified commercially insured subjects aged 18–64 years with available perioperative serum 25-hydroxyvitamin D (25D) levels who underwent one of nine major surgical procedures in 2000–2014. Primary outcomes were dose and duration of opioid use measured using pharmacy claims. Secondary outcome was opioid use disorder captured using diagnosis codes. Multivariable negative binomial models with generalized estimating equations were performed examining the association between 25D levels and postoperative opioid use measures, adjusting for age, sex, race/ethnicity, Charlson score, education, income, latitude, and season of blood draw. Adjusted Cox regression was used to examine the association with opioid use disorder. RESULTS: Among 5446 subjects, serum 25(OH)D was sufficient (≥ 20 ng/mL) among 4349 (79.9%) subjects, whereas 837 (15.4%) had insufficient (12 to
- Published
- 2020
6. Potentially Inappropriate Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011-2015
- Author
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Adam J. Rose, Dana Bernson, Thomas Land, Alexander Y. Walley, Marc R. Larochelle, Kenneth Chui, Bradley D. Stein, and Thomas J. Stopka
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Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,Inappropriate Prescribing ,01 natural sciences ,Cohort Studies ,03 medical and health sciences ,Benzodiazepines ,0302 clinical medicine ,Internal medicine ,Cause of Death ,Outcome Assessment, Health Care ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Medical prescription ,Practice Patterns, Physicians' ,Adverse effect ,Aged ,Original Research ,Aged, 80 and over ,Benzodiazepine ,business.industry ,Proportional hazards model ,010102 general mathematics ,Hazard ratio ,Opioid overdose ,Middle Aged ,medicine.disease ,Analgesics, Opioid ,Opioid ,Massachusetts ,Drug Therapy, Combination ,Female ,Drug Overdose ,business ,Cohort study ,medicine.drug - Abstract
BACKGROUND: Potentially inappropriate prescribing (PIP) may contribute to opioid overdose. OBJECTIVE: To examine the association between PIP and adverse events. DESIGN: Cohort study. PARTICIPANTS: Three million seventy-eight thousand thirty-four individuals age ≥ 18, without disseminated cancer, who received prescription opioids between 2011 and 2015. MAIN MEASURES: We defined PIP as (a) morphine equivalent dose ≥ 100 mg/day in ≥ 3 months; (b) overlapping opioid and benzodiazepine prescriptions in ≥ 3 months; (c) ≥ 4 opioid prescribers in any quarter; (d) ≥ 4 opioid-dispensing pharmacies in any quarter; (e) cash purchase of prescription opioids on ≥ 3 occasions; and (f) receipt of opioids in 3 consecutive months without a documented pain diagnosis. We used Cox proportional hazards models to identify PIP practices associated with non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality, controlling for covariates. KEY RESULTS: All six types of PIP were associated with higher adjusted hazard for all-cause mortality, four of six with non-fatal overdose, and five of six with fatal overdose. Lacking a documented pain diagnosis was associated with non-fatal overdose (adjusted hazard ratio [AHR] 2.21, 95% confidence interval [CI] 2.02–2.41), as was high-dose opioids (AHR 1.68, 95% CI 1.59–1.76). Co-prescription of benzodiazepines was associated with fatal overdose (AHR 4.23, 95% CI 3.85–4.65). High-dose opioids were associated with all-cause mortality (AHR 2.18, 95% CI 2.14–2.23), as was lacking a documented pain diagnosis (AHR 2.05, 95% CI 2.01–2.09). Compared to those who received opioids without PIP, the hazard for fatal opioid overdose with one, two, three, and ≥ four PIP subtypes were 4.24, 7.05, 10.28, and 12.99 (test of linear trend, p
- Published
- 2018
7. Reducing Excess Cardiac Biomarker Testing at an Academic Medical Center
- Author
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Stefan Riedel, Jeffrey C. Trost, Amy M. Knight, Hardin Pantle, and Marc R. Larochelle
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medicine.medical_specialty ,business.industry ,Cardiac biomarkers ,Guideline adherence ,Extramural ,MEDLINE ,Diagnostic test ,Health care ,Unnecessary Procedure ,Internal Medicine ,Medicine ,Biomarker (medicine) ,business ,Intensive care medicine - Abstract
BACKGROUND Elimination of wasteful diagnostic testing will improve value for the United States health care system.
- Published
- 2014
8. Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System
- Author
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Richard B. Balaban, Catherine Vialle-Valentin, Alison A. Galbraith, Marc R. Larochelle, Marguerite E. Burns, Dennis Ross-Degnan, and Fang Zhang
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Adult ,Male ,Patient Transfer ,Time Factors ,Safety net ,media_common.quotation_subject ,01 natural sciences ,Patient Readmission ,03 medical and health sciences ,Patient safety ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Patient Admission ,Ambulatory care ,Nursing ,Risk Factors ,Health care ,Internal Medicine ,Ambulatory Care ,Medicine ,Humans ,Patient Navigation ,030212 general & internal medicine ,0101 mathematics ,health care economics and organizations ,Medical systems ,media_common ,Aged ,Heart Failure ,Patient Navigator ,business.industry ,Delivery of Health Care, Integrated ,digestive, oral, and skin physiology ,010102 general mathematics ,Age Factors ,Capsule Commentary ,Hospital based ,Length of Stay ,Middle Aged ,Payment ,Outcome and Process Assessment, Health Care ,Female ,business ,Emergency Service, Hospital ,Program Evaluation - Abstract
With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies.To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period.Randomized controlled trial conducted October 2011 through April 2013.Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease. The analytic sample included 739 intervention patients, 1182 controls.Through hospital visits and 30 days of post-discharge telephone outreach, PNs provided coaching and assistance with medications, appointments, transportation, communication with primary care, and self-care.Primary outcomes: (1) hospital-based utilization, a composite of ED visits and hospital admissions; (2) hospital admissions; (3) ED visits; and (4) outpatient visits. We evaluated outcomes following an index discharge, stratified by patient age (≥ 60 and60 years), using a 180-day time frame divided into six 30-day periods.The PN program produced starkly different outcomes by patient age. Among older PN patients, hospital-based utilization was consistently lower than controls, producing an 18.7% cumulative decrease at 180 days (p = 0.038); outpatient visits increased in the critical first 30-day period (p = 0.006). Among younger PN patients, hospital-based utilization was 31.7% (p = 0.038) higher at 180 days, largely reflecting sharply higher utilization in the initial 30 days (p = 0.002), with non-significant changes thereafter; outpatient visits experienced no significant changes.A PN program serving high-risk safety-net patients differentially impacted patients based on age, and among younger patients, outcomes varied over time. Our findings highlight the importance for future research to evaluate care transition programs among different subpopulations and over longer time periods.
- Published
- 2016
9. Frontline Account: Targeting Hot Spotters in an Internal Medicine Residency Clinic
- Author
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Marc R. Larochelle, Laura A. Hanyok, Fernanda Porto-Carreiro, Melissa Dattalo, Eunice Yu, Stephanie Nothelle, and Sean Tackett
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Geriatrics ,medicine.medical_specialty ,education.field_of_study ,Outpatient Clinics, Hospital ,business.industry ,Frontline Account ,Public health ,education ,Population ,Medical school ,Internship and Residency ,Patient-centered care ,humanities ,House Calls ,Patient-Centered Care ,Internal medicine ,Family medicine ,Health care ,Internal Medicine ,medicine ,House call ,Humans ,business - Abstract
Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA; Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial VA Hospital, Madison, WI, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
- Published
- 2014
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