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INTRODUCTION: Both microvascular decompression (MVD) and stereotactic radiosurgery (SRS) have been demonstrated to be effective in treating medically refractory trigeminal neuralgia. However, there is controversy over which one offers more durable pain relief and the patient selection for each treatment. We used a decision analysis model to calculate the health-related quality of life (QOL) for each treatment. METHODS: We searched PubMed and the Cochrane Database of Systematic Reviews for relevant articles on MVD or SRS for trigeminal neuralgia published between 2000 and 2015. Using data from these studies, we modeled pain relief and complication outcomes and assigned QOL values. A sensitivity analysis using a Monte Carlo simulation determined which procedure led to the greatest QOL. RESULTS: MVD produced a significantly higher QOL than SRS at a seven-year follow-up. Additionally, MVD patients had a significantly higher rate of complete pain relief and a significantly lower rate of complications and recurrence. CONCLUSIONS: With a decision-analytic model, we calculated that MVD provides more favorable outcomes than SRS for the treatment of trigeminal neuralgia.
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OBJECTIVE: The purpose of this study was to decrease problematic benzodiazepine (BZD) prescriptions provided to patients enrolled in methadone maintenance treatment (MMT) programs in an urban setting through a quality improvement intervention. METHODS: A prospective, interactive, feedback loop was used with 4 MMT providers over a period of 5 years (2009-2013) to help reduce the number of BZD prescriptions that clients were receiving from other providers. To track individuals who were receiving a BZD prescription from an outside provider, MMT medical teams were provided with patient-level Medicaid pharmacy claims data every month for 5 years. A technical assistance team, comprised of a medical director, pharmacists, data analysts, clinical, and management information staff at a behavioral health managed care organization experienced in MMT, met with each of the 4 MMT providers at several time points to devise methods of reducing problematic BZD prescriptions and engaging community medical providers. RESULTS: A total of 3464 Medicaid eligible adults were included in the quality improvement project over the 5-year period. The overall rate of BZD prescriptions provided to patients decreased significantly, from 37% at the beginning of 2009, to 27% at the end of 2013. Three out of the 4 MMT programs showed a significant decrease in BZD prescriptions among their participants. CONCLUSIONS: The 4 MMT providers involved in the study found the ongoing feedback loops valuable in the process of managing the health risks of their MMT patients.