Literature Collection

OBJECTIVES: Hospital employment of physicians, often called hospital-physician vertical integration, has become widespread in health care delivery, but whether hospital employment tilts the case mix of physicians toward higher-complexity patients remains unknown. STUDY DESIGN: Cross-sectional and difference-in-differences analysis of 2014-2019 Medicare Standard Analytic Files. METHODS: We compared pre- and postemployment patient panels of primary care physicians who did and did not become hospital employees, analyzing changes in the prevalence of chronic conditions. We measured arthritis, depression, diabetes, hypertension, and ischemic heart disease. We also evaluated whether patients who were dropped from physician panels found alternative sources of primary care. RESULTS: Hospital-employed physicians treated patients of similar or better health; for instance, 54% of integrated physicians' patients had 2 or more chronic conditions compared with 56% among independent physicians (P < .001). After becoming hospital employees, physicians treated approximately 10% fewer Medicare patients (-9.5%; 95% CI, -11.3% to -7.7%). Within physician panels, the prevalence of patients with 2 or more chronic conditions did not significantly change after employment relative to independent physicians (-1.1%; 95% CI, -2.3% to 0.2%). Approximately 37% of patients were dropped from physician panels after employment; these patients were less likely to find alternative primary care compared with those dropped from independent physician panels (P < .001). CONCLUSIONS: Hospital employment of physicians resulted in neither a higher number nor a higher proportion of complex patients treated by integrated physicians, at least among traditional Medicare patients.

OBJECTIVE: The aim is to assess the impact of long-acting buprenorphine (LAI-BNP) on frequency of methamphetamine (MA) use. METHODS: We undertook an observational, descriptive, retrospective cohort study of patients of a public, tertiary, community-based Alcohol and Other Drug Service (AODS) with opioid use disorder (OUD) treated with LAI-BNP who are current or past users of MA. We assessed the changes of frequency of use in their MA use at start (baseline), 3 and 6 months of LAI-BNP. RESULTS: Study included 59 participants. Based on their MA use at the commencement of LAI-BNP, the sample was further sub-grouped as active users (n = 30) and past users (n = 29). At 6 months of LAI-BNP, all the past users remained abstinent from MA use. 70% (n = 21) of participants with active MA use had reduced or ceased their MA use while 17% (n = 5) increased their MA use at 6 months. CONCLUSIONS: The results favour the use of LAI-BNP as a potential treatment for MA use.