West Virginia Medical Cannabis: Patient and Physician Interest Survey Results and Other Data Loretta Haddy, PhD, MS State Epidemiologist December 14, 2017 WV Medical Cannabis Advisory Board Presentation Summary • • • • • • • • Objectives for Data Set Analyses Patient Interest Survey Provider Interest Survey Other Available Data Systems Methods and Result Narrative Statements for Each Data Set Graphics for Data Summaries County and Public Health District Maps Zip Code Maps: Patient Survey, Cancer Data, Medicaid and Medicare Data 1 Data Objectives for Patient Survey Method: Survey online October 14, 2017 - November 20, 2017 Results: • 6,174 responses (62 by mail and 6,112 online) • Patient provided zip code and interest in medical cannabis • 6,003 surveys analyzed, 171 were out of state zip codes so not included in analysis • Patients diagnosed with serious medical condition(s) • Mapped serious medical conditions by patient zip code • Most respondents indicated they were a patient or a family member was a patient • Patients indicated how far they would travel to a dispensary • Most frequent “other condition” response was related to anxiety disorders 2 Results - Patient Survey Number of Responses Reported Interest in Use of Medical Cannabis, West Virginia, 2017 5,000 4,033 4,000 3,000 1,813 2,000 364 611 1,000 0 I am a patient with My family member a serious medical has a serious condition. medical condition. I am a caregiver of a patient with a serious medical condition. Reported Role Other (please specify) 3 Results - Patient Survey (cont’d) Counties from which Patient Respondents Reported, West Virginia, 2017 4 WEST VIRGINIA Departmental VResour BUREAU FOR PUBLIC HEALTH 211 to 2:12 I 1311:1211 . 151 3111:. 15.1 1 1:3 31 5 Results - Patient Survey (cont’d) Number of Respondents Age Ranges of Patient Respondents, West Virginia, 2017 1,808 2000 1,360 1600 1,410 1,240 1200 800 400 530 209 0 0-18 years of age 19-25 years of age Note: Respondents may have selected more than one option. 26-35 years of age 36-45 years of age Age Ranges 46-55 years of age 56 years of age and older 6 Results - Patient Survey (cont’d) Number of Responses Diagnoses Reported by Patient Respondents, West Virginia, 2017 2,370 2,500 2,120 2,000 1,579 1,500 1,000 500 694 807 677 522 457 370 51 17 112 0 Serious Medical Condition Note: Respondents may have selected more than one condition. 7 Results - Patient Survey (cont’d) Types of Diagnoses Listed Under "Other, Please Specify" as Indicated by Patients, West Virginia, 2017 Percent of “Other” Responses Type of Diagnosis 0% Addiction Allergy Asthma Arthritis Autoimmune Cardiac Circulatory COPD Diabetes Digestive Fibromyalgia Genetic Disorder Glaucoma Hepatic Infectious Disease Injury Malignancies Mental/Behavioral Health Musculoskeletal Pain Neurologic Provider Renal Reproductive Respiratory Unspecified Unspecified Pain Urinary Vascular 5% 10% 5 30% 35% 40% 45% 179 34 46 20 35 20 138 3 3 25% 198 171 15 2 16 32 57 2 20% 20 1 2 3 15% 980 215 20 18 37 99 8 Results - Patient Survey (cont’d) Patients Indicating Communication with Their Health Care Provider Regarding Medical Cannabis West Virginia, 2017 Unsure 15% Other 4% Yes 43% No 38% 9 Results - Patient Survey (cont’d) Health Care Provider With Whom Patients Discussed Use of Medical Cannabis, West Virginia, 2017 Number of Responses 2,837 3,000 2,500 2,000 1,427 1,500 1,000 471 512 768 546 500 0 Medical Doctor (MD) Doctor of Osteopathic Medicine (DO) Nurse Practitioner (NP) Physician Assistant (PA) Type Of Health Care Provider Unsure Other (please specify) 10 Results - Patient Survey (cont’d) Specialty of Health Care Provider as Indicated by Patient, West Virginia Medical Cannabis Patient Interest Survey, 2017 2370 Family Medicine Unsure Psychiatry Neurological Surgery Internal Medicine Rheumatology Orthopedic Surgery Gastroenterology Hematology & Oncology Endocrinology Hospital-Based Pediatric Subspecialties Emergency Medicine Nephrology Cardiology General Surgery Urology Obstetrics & Gynecology Infectious Disease Addictionologist Pulmonology Allergy & Immunology Pediatrics Anesthesiology Radiology-Diagnostics Ophthalmology Dermatology Pathology Anatomic and Clinical Plastic Surgery 1294 754 580 SPECIALTY 375 303 265 251 176 159 132 108 107 97 97 87 73 73 71 62 53 48 43 36 35 34 32 15 8 0.0 500.0 11 1,000.0 NUMBER OF RESPONSES 1,500.0 2,000.0 2,500.0 Results - Patient Survey (cont’d) Patients Indicating Designation of Caregiver to Obtain Medical Cannabis, West Virginia, 2017 Yes 22% Unsure 29% No 49% 12 Results - Patient Survey (cont’d) Ability and Willingness of Respondents to Drive to Purchase Medical Cannabis, West Virginia, 2017 No 6% Unsure 10% Yes 84% 13 Results - Patient Survey (cont’d) Number of Responses Distance Respondents Indicated Willingness to Drive to Purchase Medical Cannabis, West Virginia, 2017 2,175 2,500 1,959 2,000 1,456 1,500 911 1,000 219 500 0 0-10 miles 11-25 miles 26-50 miles 50 or more miles Other (please specify) Number of Miles 14 Results - Patient Survey (cont’d) Number of Responses Preferred Form of Medical Cannabis as Indicated by Patient Respondents, West Virginia, 2017 3,029 3,500 3,000 2,264 2,500 2,000 2,058 1,443 1,299 1,108 1,500 911 1,000 500 0 Pill Oil Topical Vaporization forms, or including gel, nebulization creams or (excluding ointments dry leaf or plant form) Tincture Preferred Form of Cannabis Liquid No preference 15 Data Objectives for Physician Survey Method: Survey available October 24, 2017 – November 14, 2017 • Medical boards sent email to licensed physicians with link to survey Results: • Total of 1,455 physicians completed online survey • 1,190 physicians interested; 265 not interested in medical cannabis • Physicians indicated practice environments, specialties, and counties in which they practice • 28 specialties indicated by respondents • Physicians indicated the serious medical conditions for which they provide care • Physicians asked to indicate awareness of the 4-hour training course requirement for certifying physicians; most were not aware • Physicians indicated interest in medical cannabis treatment 16 Results - Physician Survey Practice Environment of Physicians, West Virginia, 2017 575 Number of Respondents 600 500 400 275 300 188 152 200 78 100 0 Private Practice Group Practice Hospital System FQHC or Primary Care Clinic Other Practice Environment 17 Results - Physician Survey (cont’d) Specialty Specialties Indicated by Physicians, West Virginia, 2017 Family Medicine Internal Medicine Emergency Medicine Hospital-based Psychiatry Orthopedic Surgery Anesthesiology Obstetrics & Gynecology Pediatrics General Surgery Pediatric Subspecialty Hematology & Oncology Pathology Radiology-Diagnostics Pulmonology Addictionologist Cardiology Neurosurgery Ophthalmology Dermatology Endocrinology Urology Infectious Disease Nephrology Rheumatology Plastic Surgery Allergy & Immunology Gastroenterology 43 41 34 34 31 28 26 22 19 14 10 9 8 8 7 6 5 5 0 50 181 117 67 64 59 57 56 52 51 100 Number of Respondents 150 200 238 250 18 Results - Physician Survey (cont?d) @3311 --.-: ReSOurces BUREAU FOR PUBLIC HEALTH Counties Where Physicians Practice, West Virginia, 2017 HANCOCK BROOKE OHIO MARSHALL MONONGAUA WETZEL MORGAN TYLER MARION PRESTON MINERAL PLEASANTS BERKELEY HARRISON TAYLOR HAMPSHIRE JEFFERSON DODDRIDGE WOOD RITCHIE BARBOUR GRANT TUCKER WIRT HARDY GILMER LEWIS UPSHUR JACKSON CALHOUN RANDOLPH MASON ROANE BRAXTON PENDLETON WEBSTER CLAY NICHOLAS POCAHONTAS LINCOLN WAYNE BOONE FAYETTE GREENBRIER LOGAN 45 88 MINGO 89 132 WYOMING SUMMERS 133 - 175 MONROE 177 - 220 I I 221 19 MCDOWELL MERCER Serious Medical Conditions Combined • Related disorders were combined: • Seizure Disorders • Epilepsy • Intractable Seizures • Spasticity Disorders • Amyotrophic Lateral Sclerosis (ALS) • Huntington’s Disease • Parkinson’s Disease • Multiple Sclerosis (MS) 20 Results - Physician Survey (cont’d) Provide Care for Serious Medical Conditions, West Virginia, 2017 1600 1,433 Number of Responses 1400 1200 1000 800 600 400 200 638 495 610 518 423 497 444 241 118 142 0 Serious Medical Conditions 21 Results - Physician Survey (cont’d) Respondents Indicating Awareness of 4-hour Training Course Requirement, West Virginia Physician Survey, 2017 Yes 36% No 64% 22 Results - Physician Survey (cont’d) Interest Shown by Respondents, West Virginia Physician Survey, 2017 No 18% Yes 82% 23 Data Objectives for Other Data Systems Method: • Most recent three years of available data • Determine location of person with serious medical conditions • ICD 9-10 code data for serious medical conditions Results: • PEIA active membership with serious medical conditions • West Virginia HIV/AIDS Registry Patients Living with HIV/AIDS (PLWHA) by Public Health District in 2017 • West Virginia Cancer Registry (January 2012 - December 2014) incidence data by zip code • Medicaid (January 2015 - June 2017) by zip code • Medicare (January 2015 - June 2017) by zip code 24 Results - PEIA WV Public Employees Insurance Agency (PEIA) • Currently has 152,000 insured active members • Data Set: • Fiscal Years January 2015 – June 2017 • Count of active members with claims that include diagnosis codes for the applicable serious medical conditions • Patient duplicates have been removed from each condition claim count; however, patients with multiple conditions are represented within each condition total • The HIPAA Privacy Rule does not allow PEIA to provide diagnoses information by geographic area in a unit smaller than a state Source: PEIA 25 Results - PEIA (cont’d) PEIA Claims by Medical Condition, West Virginia, January 2015 - June 2017 Number of Claims 10,000 8,632 8,378 8,000 6,561 6,289 6,000 4,000 2,000 1,332 660 71 995 28 0 Source: PEIA Serious Medical Conditions 26 Results - PEIA (cont’d) PEIA Claims by Medical Condition, West Virginia, 2015-2017 Sickle Cell Anemia Spasticity HIV/AIDS < 1.0% Disorders < 1.0% 3.0% PTSD 19.1% Neuropathies 26.2% Other 9.4% Chronic Pain 19.9% Cancer 25.4% Source: PEIA Seizure Disorders 4.0% Crohn's Disease 2.0% 27 Results - HIV/AIDS Registry HIV/AIDS Registry Data • West Virginia residence at the time of diagnosis who are still living in 2017 • Annual review of people living with HIV/AIDS (PLWHA) with reported lab results indicating still in care • Small number of cases (<5) prevented mapping data by zip code • Conduct National Death match two times a year to identify if living • Annual case comparison with other states - deletes duplicates 28 Distribution of People Living with HIv/Alos (PvaH) lav Public Health Management District in West Virginia? October 2017 BROOKE DHID DISTRICT 6 1nd MA RSHAL MORGAN WETZEL DISTRICT DISTRICT 5 122 JEFFERSON DISTRICT 3 313 Cases 403 DISTRICT 3 ?5 100 - 200 4 POCAHONTAS 201 - 300 GREENBRIER DISTRICTII 301 400 4 . DISTRICT 2 235 I 401 DISTRICT 1 233 Data Source: 'West Virginia Department of Health and Human Resources Total PLWHA in West Uirgi ?Ia: 1,348 Bureau of Public Health, Cl?ice of Epidemiology and Prevention Services, Exdudeg [radar-3 prisoners. 29 Division of STD and HIV, HIVIAIDE Surveilla noe Program Results - Cancer Registry Cancer Registry Data • Number of invasive cancer (and in situ cancer) for the years 2012-2014 by zip code • Incidence cases reported by zip code based on patient’s address at the time of diagnosis 30 . A Ham BUREAU FOR PUBLIC HEALTH ilEto 53? 317 tnResults - Medicaid West Virginia Medicaid Serious Medical Condition Claims Data • Data generated from West Virginia Medicaid Data Warehouse • Data Set: • Data from January 2015 - June 2017 • Used ICD9/10 codes for serious medical conditions • Count of active members with claims that include diagnosis codes for the applicable serious medical conditions by zip code Source: West Virginia Medicaid Data Warehouse 32 Results - Medicaid (cont’d) Medicaid Serious Medical Condition Claims, West Virginia, January 2015 - June 2017 68,117 Number of Claims 70,000 60,000 46,787 50,000 40,000 20,819 30,000 20,000 10,000 0 2015 2016 2017 Year of Claim Source: West Virginia Medicaid Data Warehouse 33 Results - Medicaid (cont’d) Medicaid Claims by Serious Medical Condition, West Virginia, January 2015 - June 2017 Number of Claims 60,000 55,666 50,000 40,000 30,000 25,101 23,869 20,000 10,000 8,578 10,692 3,738 2,273 5,348 245 213 0 Source: West Virginia Medicaid Data Warehouse Serious Medical Condition 34 Results - Medicaid (cont’d) Medicaid Claims by Medical Condition West Virginia, January 2015-June 2017 Chronic Pain 18% Seizure Disorders 18% Sickle Cell <1% PTSD 8% Other 23% Neuropathies 6% Cancer 41% Terminally Ill <1% HIV/AIDS 2% Source: West Virginia Medicaid Data Warehouse Spasticity Disorders 4% Crohn’s Disease 3% 35 2336 to 3.127 2.345 to 1.36 1.563 to 1.954 1.1.72 to 1.563 7'81 to 1.1.72 39C to 7'81 3 t: 393 WEST VIRGINIA Departmental VResour BUREAU FOR PUBLIC HEALTH 36 Results - Medicare West Virginia Medicare Beneficiaries Data • Data generated from Quality Insights • Data Set: • Count of active members that include diagnosis codes for the applicable serious medical conditions • Patient duplicates have been removed from each condition claim count; however, patients with multiple conditions are represented within each condition total Source: Quality Insights 37 Results - Medicare (cont’d) Medicare Cases by Disease Group, West Virginia, 2017 140,000 133,796 Number of Cases 120,000 100,000 80,000 60,000 40,000 20,000 25,209 11,057 2,563 3,213 1,139 14,273 76 8,796 642 0 Serious Medical Condition Source: Quality Insights 38 Results - Medicare (cont’d) Medicare Cases by Disease Group, West Virginia, 2017 Sickle Cell Anemia <1% Chronic Pain 13% Cancer 67% Seizure Disorders 7% Other 20% PTSD 1% Neuropathies 5% HIV/AIDS 1% Source: Quality Insights Spacicity Disorders 4% Terminally Ill <1% Crohn's Disease 2% 39 WEST VIRGINIA Medicare Serious Medical Conditions by Zip Code, 2015-2017 BUREAU FOR PUBLIC HEALTH 3211t0242 3181t0211 =-91t3121 =-Eit391 hSit??i ito?i 40 WESTVIRGINIA De Healtl'lk?n 23?: i: ?90 5 BUREAU FOR PUBLIC HEALTH Patient Survey, Cancer, Medicaid Medicare by Zip Code 1.933 to 1.416 tn:- 1.933 '36? to 1.45'3 to ?36? 1 ts 4.34 41 Acknowledgements THANK YOU Medical Cannabis Data Team Allysa Crews Alex Daniels Bijal Patel Jessica Shlitz Melissa Scott Ashley Simmons Tonya Yablonsky 42 Contact Information Loretta Haddy, PhD, MS State Epidemiologist West Virginia Department of Health and Human Resources Bureau for Public Health Commissioner’s Office Phone: (304) 356-4077 Fax: (304) 558-1035 Email: Loretta.E.Haddy@wv.gov 43