Publications by authors named "Joshua Fenton"
Article Synopsis
- The study investigated the impact of tapering off chronic opioid use on pain-related healthcare utilization, including emergency department visits and hospitalizations.
- Conducted from 2015-2019 with over 47,000 adult patients, the research found that tapering opioids led to more emergency visits and hospitalizations but fewer primary care visits related to pain.
- Overall, the findings suggest that while tapering may be intended to reduce opioid use, it could lead to an increase in acute pain-related healthcare needs.
Importance: Acute back pain is a common reason for primary care visits and often results in low-value spinal imaging.
Objective: To evaluate the effect of a standardized patient-delivered intervention on rates of low-value spinal imaging among primary care patients with acute low back pain.
Design, Setting, And Participants: In this randomized clinical trial, physicians or advanced practice clinicians were recruited from March 22 to August 5, 2021, from 10 adult primary care or urgent care clinics in Sacramento, California.
Context: Health plan disenrollment may disrupt chronic or preventive care for patients prescribed long-term opioid therapy (LTOT).
Purpose: To assess whether overdose events in patients prescribed LTOT are associated with subsequent health plan disenrollment.
Design: Retrospective cohort study.
Study Design: Retrospective cohort study.
Objective: To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.
Summary Of Background Data: Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.
Importance: Opioid tapering has been associated with negative consequences, such as increased overdoses and mental health needs. Tapering could also alter use of health care services and worsen care of comorbid conditions through disruption in primary care.
Objective: To evaluate tapering of stable long-term opioid therapy (LTOT) and subsequent health care service use and chronic condition care.
Objectives: Effective communication skills are essential for optimally managing chronic pain and opioids. This exploratory, sequential mixed methods study tested the effect of a novel framework designed to improve pain-related communication and outcomes.
Methods: Study 1 developed a novel 5-step framework for helping primary care clinicians discuss chronic pain and opioids with patients.
Importance: Patients prescribed long-term opioid therapy are increasingly undergoing dose tapering. Recent studies suggest that tapering is associated with short-term risks of substance misuse, overdose, and mental health crisis, although lower opioid dose could reduce risks of adverse events over the longer term.
Objective: To assess the longer-term risks of overdose or mental health crisis associated with opioid dose tapering.
Background: Informed treatment decision-making necessitates accurate prognostication, including predictions about quality of life.
Aims: We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement.
Materials & Methods: We conducted secondary analyses of clinical trial data.
Background: Unhealthy alcohol use is a significant health issue for the US population. The US Preventive Services Task Force (USPSTF) recommends screening adults 18 years or older for unhealthy alcohol use during primary care visits.
Objectives: To evaluate alcohol screening among ambulatory visits made by US adult primary care patients and identify characteristics predictive of alcohol screening.
Importance: Opioid-related mortality and national prescribing guidelines have led to tapering of doses among patients prescribed long-term opioid therapy for chronic pain. There is limited information about risks related to tapering, including overdose and mental health crisis.
Objective: To assess whether there are associations between opioid dose tapering and rates of overdose and mental health crisis among patients prescribed stable, long-term, higher-dose opioids.
Objective: To evaluate the dose trajectory of new opioid tapers and estimate the percentage of patients with sustained tapers at long-term follow-up.
Design: Retrospective cohort study.
Setting: Data from the OptumLabs Data Warehouse® which includes de-identified medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees, representing a diverse mixture of ages, ethnicities, and geographical regions across the United States.
Background: Patients with acute low back pain frequently request diagnostic imaging, and clinicians feel pressure to acquiesce to such requests to sustain patient trust and satisfaction. Spinal imaging in patients with acute low back pain poses risks from diagnostic evaluation of false-positive findings, patient labeling and anxiety, and unnecessary treatment (including spinal surgery). Watchful waiting advice has been an effective strategy to reduce some low-value treatments, and some evidence suggests a watchful waiting approach would be acceptable to many patients requesting diagnostic tests.
View Article and Find Full Text PDFContext: Health plan disenrollment has been associated with higher mortality in patients with opioid use disorder. Insurance loss and health plan disenrollment might be downstream social consequences of opioid misuse and overdose that may heighten patient mortality risks during a period of heightened need for professional assistance. Objective: To test hypotheses that: 1) overdose events in patients prescribed long-term opioids are associated with subsequent health plan disenrollment; and 2) buprenorphine initiation after overdose would attenuate this association.
View Article and Find Full Text PDFPurpose: To assess the reliability of peer review of abstracts submitted to academic family medicine meetings in North America.
Methods: We analyzed reviewer ratings of abstracts submitted: 1) as oral presentations to the North American Primary Care Research Group (NAPCRG) meeting from 2016 to 2019, as well as 2019 poster session or workshop submissions; and 2) in 12 categories to the Society of Teachers of Family Medicine (STFM) Spring 2018 meeting. In each category and year, we used a multi-level mixed model to estimate the abstract-level intraclass correlation coefficient (ICC) and the reliability of initial review (using the abstract-level ICC and the number of reviewers per abstract).
Background: The exponential growth of the biomedical literature necessitates investigating strategies to reduce systematic reviewer burden while maintaining the high standards of systematic review validity and comprehensiveness.
Methods: We compared the traditional systematic review screening process with (1) a review-of-reviews (ROR) screening approach and (2) a semi-automation screening approach using two publicly available tools (RobotAnalyst and AbstrackR) and different types of training sets (randomly selected citations subjected to dual-review at the title-abstract stage, highly curated citations dually reviewed at the full-text stage, and a combination of the two). We evaluated performance measures of sensitivity, specificity, missed citations, and workload burden RESULTS: The ROR approach for treatments of early-stage prostate cancer had a poor sensitivity (0.
Background: Physician denial of patient requests is associated with lower patient satisfaction. Our objective was to explore factors that influence physician request denial and patient satisfaction after request denial.
Methods: Cross-sectional observational study of 1141 adult patients seen during 1319 outpatient visits with 56 primary care physicians.
Importance: A 2016 Centers for Disease Control and Prevention prescribing guideline cautioned against higher-dose long-term opioid therapy and recommended tapering daily opioid doses by approximately 10% per week if the risks outweigh the benefits. Warnings have since appeared regarding potential hazards of rapid opioid tapering.
Objectives: To characterize US trends in opioid dose tapering among patients prescribed long-term opioids from 2008 to 2017 and identify patient-level variables associated with tapering and a more rapid rate of tapering.
In this essay, the author analyzes contributions from the American Academy of Family Physician's (AAFP's) political action committee (FamMedPAC) during the 2018 election cycle. The author highlights discrepancies between explicit AAFP legislative priorities and the voting records and public positions of Congressional members who received FamMedPAC support during the election cycle. The analysis raises questions about FamMedPAC's decision-making process for allocating support to candidates.
View Article and Find Full Text PDFCare teams are increasingly expected to attend to the needs of patient's personal caregivers (e.g., family members).
View Article and Find Full Text PDFBackground: In a prior study, we found patient satisfaction was associated with mortality. However, that study included few deaths, yielding wide confidence intervals, was criticized for possible morbidity under-adjustment, and lacked power to explore sociodemographic moderation.
Objective: To revisit the satisfaction-mortality association in a larger national sample, allowing more precise risk estimates, sequential morbidity adjustment, and exploration of sociodemographic moderation.
Background: In caring for patients with advanced cancer, accurate estimation of survival is important for clinical decision making. The purpose of this study was to assess the accuracy of 2-year survival probabilities estimated by oncologists, patients, and caregivers and to identify demographic and clinical factors associated with prognostic accuracy.
Methods: This was a secondary observational analysis of data obtained from a cluster randomized controlled trial.