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From Patients to Policy: Population Intervention Effects in Epidemiology.

ABSTRACT: Interest in implementation science and recent calls for consequentialist epidemiology urge epidemiologists to produce work more immediately applicable to public health practice. A clear vocabulary for such approaches is lacking. Here, we present a potential taxonomy of causal effects, distinguishing between "exposure effects" more relevant to patients and individuals; and "population intervention effects" more relevant to public health policy. We discuss this range of effects using figures and a simple numerical example.

SUBMITTER: Westreich D

PROVIDER: S-EPMC5453818 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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From Patients to Policy: Population Intervention Effects in Epidemiology.

Westreich Daniel D

Epidemiology (Cambridge, Mass.) 20170701 4

Interest in implementation science and recent calls for consequentialist epidemiology urge epidemiologists to produce work more immediately applicable to public health practice. A clear vocabulary for such approaches is lacking. Here, we present a potential taxonomy of causal effects, distinguishing between "exposure effects" more relevant to patients and individuals; and "population intervention effects" more relevant to public health policy. We discuss this range of effects using figures and a ...[more]

PMID: 28282339

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Project description:BackgroundIn response to the opioid epidemic, many states have enacted policies limiting opioid prescriptions. There is a paucity of evidence of the impact of opioid prescribing interventions in primary care populations, including whether unintended consequences arise from limiting the availability of prescribed opioids.ObjectiveOur aim was to compare changes in opioid overdose and related adverse effects rate among primary care patients following the implementation of state-level prescribing policies.DesignA cohort of primary care patients within an interrupted time series model.ParticipantsElectronic medical record data for 62,776 adult (18+ years) primary care patients from a major medical center in Vermont from January 1, 2016, to June 30, 2018.InterventionsState-level opioid prescription policy changes limiting dose and duration.Main measuresChanges in (1) opioid overdose rate and (2) opioid-related adverse effects rate per 100,000 person-months following the July 1, 2017, prescription policy change.Key resultsAmong primary care patients, there was no change in opioid overdose rate following implementation of the prescribing policy (incidence rate ratio; IRR: 0.64, 95% confidence interval; CI: 0.22-1.88). There was a 78% decrease in the opioid-related adverse effects rate following the prescribing policy (IRR: 0.22, 95%CI: 0.09-0.51). This association was moderated by opioid prescription history, with decreases observed among opioid-naïve patients (IRR: 0.18, 95%CI: 0.06-0.59) and among patients receiving chronic opioid prescriptions (IRR: 0.17, 95%CI: 0.03-0.99), but not among those with intermittent opioid prescriptions (IRR: 0.51, 95%CI: 0.09-2.82).ConclusionsLimiting prescription opioids did not change the opioid overdose rate among primary care patients, but it reduced the rate of opioid-related adverse effects in the year following the state-level policy change, particularly among patients with chronic opioid prescription history and opioid-naïve patients. Limiting the quantity and duration of opioid prescriptions may have beneficial effects among primary care patients.

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From Patients to Policy: Population Intervention Effects in Epidemiology.

Publications

From Patients to Policy: Population Intervention Effects in Epidemiology.

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