Jeffrey Bratberg, PharmD

Clinical Professor


Advance-CTR Pilot Projects Program (2018)

"New Methods to Evaluate the Effects of Opioids in Provider-Based Networks"
Co-PI: Ashley Buchanan, DrPH (Contact PI)

What often begins as treatment for pain management, evolves into opioid use disorder (OUD) and eventual mortality. While the mechanism by which patients prescribed opioids may face OUD has been documented, the impact of opioids prescriptions on the health outcomes of other patients within provider-based networks is less well known. Patients within provider-based networks likely exert social influence on each other’s treatment preferences and subsequent health outcomes due to shared providers and geographical proximity, which could impact social norms around opioid misuse and OUD treatment. Research-to-date has been impeded due to a lack of methods to estimate how prescription opioids permeate a provider-based network and evaluation has been based only on overall effects, which typically underestimate the full intervention impact. We will develop causal inference statistical methodology to address some remaining challenges for estimation of effects in retrospective observational studies with dissemination. We will apply these novel methods to gain new knowledge about the causal effects of prescription opioids when social influence is present and causal pathways of the spread of opioid misuse and MAT uptake within provider-based networks. In this project, we will address such questions as how to best distribute naloxone to reduce opioid overdoses among patients co-prescribed opioids. The results of this work will be motivated by and applied to the following administrative health claims databases: Optum® ClinformaticsTM Data Mart and Rhode Island (RI) Medicaid Program, where there will be individual effects on patients prescribed opioids and disseminated effects among their provider-network members. By applying our methods to the RI Medicaid Program data, we will be able to evaluate such important questions as rates of naloxone and opioid co-prescribing in the state of Rhode Island. This uniquely positions our team to develop and evaluate novel interventions to improve opioid prescribing practices among providers in Rhode Island.