Publications by authors named "Ashish P Thakrar"

5 Publications

  • Page 1 of 1

A Resident-Led Intervention to Increase Initiation of Buprenorphine Maintenance for Hospitalized Patients With Opioid Use Disorder.

J Hosp Med 2021 Jun;16(6):339-344

Department of Pediatrics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background: Hospitalized patients with opioid use disorder (OUD) are rarely started on buprenorphine or methadone maintenance despite evidence that these medications reduce all-cause mortality, overdoses, and hospital readmissions.

Objective: To assess whether clinician education and a team of residents and hospitalist attendings waivered to prescribe buprenorphine increased the rate of starting patients with OUD on buprenorphine maintenance.

Design, Setting, And Participants: Quality improvement study conducted at a large, urban, academic hospital in Maryland involving hospitalized patients with OUD on internal medicine resident services.

Intervention: We developed a protocol for initiating buprenorphine maintenance, presented an educational conference, and started the resident-led Buprenorphine Bridge Team of residents and attendings waivered to prescribe buprenorphine to bridge patients from discharge to follow-up.

Measurements: The percent of eligible inpatients with OUD initiated on buprenorphine maintenance, 24 weeks before and after the intervention; engagement in treatment after discharge; and resident knowledge and comfort with buprenorphine.

Results: The rate of starting buprenorphine maintenance increased from 10% (30 of 305 eligible patients) to 24% (64 of 270 eligible patients) after the intervention, with interrupted time series analysis showing a significant increase in rate (14.4%; 95% CI, 3.6%-25.3%; P = .02). Engagement in treatment after discharge was unchanged (40%-46% engaged 30 days after discharge). Of 156 internal medicine residents, 89 (57%) completed the baseline survey and 66 (42%) completed the follow-up survey. Responses demonstrated improved resident knowledge and comfort with buprenorphine.

Conclusion: Internal medicine resident teams were more likely to start patients on buprenorphine maintenance after clinician education and implementation of a Buprenorphine Bridge Team.
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http://dx.doi.org/10.12788/jhm.3544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191766PMC
June 2021

Micro-dosing Intravenous Buprenorphine to Rapidly Transition From Full Opioid Agonists.

J Addict Med 2021 Mar 19. Epub 2021 Mar 19.

Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (APT); Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD (LJ); Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (JR); Johns Hopkins University School of Medicine, Department of Medicine, Division of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (DAR).

For patients with opioid use disorder transitioning from methadone or requiring opioid analgesia, initiating buprenorphine for opioid use disorder can be difficult because of the risk of precipitated withdrawal. Low-dose initiation, also known as micro-dosing, is an alternative to standard initiation. Prior studies relied on nonstandard dosing of tablets or films, patches, or buccal formulations, all of which are unavailable in many hospitals. We report a novel approach to micro-dosing using intravenous buprenorphine. Two patients, one on methadone maintenance and another requiring postoperative opioid analgesia, were transitioned to buprenorphine with concurrent full-agonist opioids and without precipitated withdrawal.
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http://dx.doi.org/10.1097/ADM.0000000000000838DOI Listing
March 2021

Linking opioid use disorder treatment from hospital to community.

Addiction 2021 Aug 18;116(8):2244-2245. Epub 2021 Mar 18.

Division of Addiction Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

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http://dx.doi.org/10.1111/add.15460DOI Listing
August 2021

Child Mortality Trends: The Authors Reply.

Health Aff (Millwood) 2018 04;37(4):678

Children's Hospital of Philadelphia Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1377/hlthaff.2018.0109DOI Listing
April 2018

Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis.

Health Aff (Millwood) 2018 01;37(1):140-149

Christopher B. Forrest is a professor of pediatrics at the Children's Hospital of Philadelphia.

The United States has poorer child health outcomes than other wealthy nations despite greater per capita spending on health care for children. To better understand this phenomenon, we examined mortality trends for the US and nineteen comparator nations in the Organization for Economic Cooperation and Development for children ages 0-19 from 1961 to 2010 using publicly available data. While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US was 76 percent greater for infants and 57 percent greater for children ages 1-19. During this decade, children ages 15-19 were eighty-two times more likely to die from gun homicide in the US. Over the fifty-year study period, the lagging US performance amounted to over 600,000 excess deaths. Policy interventions should focus on infants and on children ages 15-19, the two age groups with the greatest disparities, by addressing perinatal causes of death, automobile accidents, and assaults by firearm.
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http://dx.doi.org/10.1377/hlthaff.2017.0767DOI Listing
January 2018
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