A Social Network Analysis of Provider Networks Leading to Opioid Initiation Among US Adults Volume 4 - Issue 2

Divyan Chopra1, Chenghui Li?¹, Jacob T Painter?¹, Jonathan P Bona?², Intawat Nookaew?², and Bradley C Martin?¹*

• ¹Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, USA
• ²Department of Biomedical Informatics, University of Arkansas for Medical Sciences, USA

Received:May 08, 2021;  Published: May 25, 2021

Corresponding author: Bradley C Martin, PharmD, PhD, Professor, Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences College of Pharmacy, 4301 W. Markham, slot 522 Little Rock, AR 72205, 501.603.1992 (office), USA

DOI: 10.32474/GJAPM.2021.04.000187

Fulltext PDF

To view the Full Article   Peer-reviewed Article PDF

Abstract

Background: About 38% of U.S. adults use prescription opioids. Opioid-related overdoses have risen in the last decade. Studies suggest that duration and type of first opioid prescribed play a significant role towards risky and chronic opioid use. Objective: The primary objective was to identify key players involved with initiation of patients on opioids. This study also identified patient characteristics most likely to receive care from influential opioid providers as opioid initiation interventions could be directed to such physicians.

Design/Participants: A cohort of patients with incident opioid use were identified using Arkansas All-Payer Claims Database from 2013-2018. A social network comprising provider as nodes and referrals as edges was constructed based on healthcare utilization 180 and 90 days preceding incident opioid use for potentially non-acute and potentially acute pain patients respectively.

Main Measures: Network centrality measures such as indegree (referrals received), eigenvector (neighbor centrality), betweenness (involvement) and closeness (reach) were estimated. Outcomes included influential providers determined by network centrality measures, initial opioid providers, and patients of influential providers. Covariates included provider demographics, patient demographics and clinical characteristics. Generalized linear mixed effect models were used for statistical analyses.

Key Results: There were 150,676 incident opioid users who visited 12,629 healthcare providers. Primary care providers (PCPs) were found to have higher centralities except for betweenness. Initial opioid prescribers showed higher network centralities. More complex patients such as those with more pain conditions and higher levels of comorbidity were more likely to seek opioid providers at the periphery of the network (lower indegree and eigen centrality).

Conclusions: This study highlights the characteristics of networks leading to opioid use. Findings that PCPs have higher influence and higher influence of initial opioid prescribers can guide opioid initiation guidelines as targeted interventions. Moreover, efforts should be undertaken to direct patients requiring judicious opioid prescribing to influential providers.

Keywords: Opioids; physicians; social network analysis; centrality.

Abstract| Introduction| Methods| Study Subjects| Referral Formation| Statistical Analyses| Results| Discussion| Acknowledgement| Supplementary Methods| Supplementary Methods 6: IOP| Supplementary Methods 7: RUCA| References|