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Bonilla AG, Pourat N, Chuang E, Ettner S, Zima B, Chen X, Lu C, Hoang H, Hair BY, Bolton J, Sripipatana A. Mental Health Staffing at HRSA-Funded Health Centers May Improve Access to Care. Psychiatr Serv 2021; 72:1018-1025. [PMID: 34074146 PMCID: PMC8410613 DOI: 10.1176/appi.ps.202000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment. METHODS Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64. RESULTS Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%). CONCLUSIONS Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.
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Affiliation(s)
- Amy G Bonilla
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Nadereh Pourat
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Susan Ettner
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Bonnie Zima
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Xiao Chen
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Connie Lu
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Hank Hoang
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Brionna Y Hair
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Joshua Bolton
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Alek Sripipatana
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
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Haley SJ, Moscou S, Murray S, Rieckmann T, Wells KL. The availability of alcohol, tobacco and other drug services for adults in New York State Community Health Centers. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2018.1562577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sean J. Haley
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Sharifa Murray
- Ross University School of Medicine, Roseau, Commonwealth of Dominica, West Indies
| | - Traci Rieckmann
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Kameron L. Wells
- Department of Clinical Affairs, Community Health Care Association of New York State, New York, NY, USA
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Kim TW, Bernstein J, Cheng DM, Lloyd-Travaglini C, Samet JH, Palfai TP, Saitz R. Receipt of addiction treatment as a consequence of a brief intervention for drug use in primary care: a randomized trial. Addiction 2017; 112:818-827. [PMID: 27886657 PMCID: PMC5382041 DOI: 10.1111/add.13701] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/06/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Screening, brief intervention and 'referral to treatment' programs have been promoted widely as US federal policy. Little is known about the efficacy of the RT component (referral to treatment) of brief intervention for motivating patients with unhealthy drug use identified by screening to use addiction treatment. This study aimed to compare receipt of addiction treatment following two types of brief intervention for drug use versus a no-intervention control group among primary care patients screening positive for drug use. DESIGN Secondary analyses from a single-site randomized controlled trial. SETTING Massachusetts, USA. PARTICIPANTS A total of 528 adults with Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) drug-specific scores ≥ 4. INTERVENTIONS Random assignment to: (1) a 10-15-minute brief negotiated interview (BNI) conducted by health educators (n = 174), (2) a 30-45-minute adaptation of motivational interviewing by Masters-level counselors (MOTIV) (n = 177) or (3) no BI (n = 177). All received a list of treatment and mutual help resources; both intervention protocols included dedicated staff for treatment referrals. MEASUREMENTS Receipt of any addiction treatment within 6 months after study entry, assessed in a state-wide database and hospital electronic medical record linked to trial data. FINDINGS Among 528 participants, the main drugs used were marijuana (63%), cocaine (19%) and opioids (17%); 46% met past-year drug dependence criteria (short form Composite International Diagnostic Interview); and 10% of MOTIV, 18% of BNI and 17% of control participants had any addiction treatment receipt within 6 months after study entry. There was no significant difference in addiction treatment receipt for BNI versus control [adjusted odds ratio (AOR) = 1.11; 95% confidence interval (CI) = 0.57, 2.15, Hochberg adjusted P = 0.76]. The MOTIV group had lower odds of linking to treatment (AOR = 0.36, 95% CI = 0.17, 0.78, Hochberg adjusted P = 0.02) compared with the no BI group. CONCLUSION Brief intervention delivered in primary care for screen-identified drug use did not increase addiction treatment receipt significantly; a motivational interviewing approach appeared to be counterproductive.
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Affiliation(s)
- Theresa W. Kim
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit
| | - Judith Bernstein
- Boston University School Public Health, Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences (JB, JHS, RS)
| | - Debbie M. Cheng
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit,Boston University School Public Health, Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences (JB, JHS, RS)
| | - Christine Lloyd-Travaglini
- Boston University School Public Health, Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences (JB, JHS, RS)
| | - Jeffrey H Samet
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit,Boston University School Public Health, Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences (JB, JHS, RS)
| | - Tibor P. Palfai
- Boston University, Department of Psychological and Brain Sciences
| | - Richard Saitz
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit,Boston University School Public Health, Department of Biostatistics (DMC), Data Coordinating Center (CLT), Department of Community Health Sciences (JB, JHS, RS)
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Savic M, Best D, Manning V, Lubman DI. Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:19. [PMID: 28388954 PMCID: PMC5384147 DOI: 10.1186/s13011-017-0104-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/30/2017] [Indexed: 01/09/2023]
Abstract
Background There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. Methods We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. Results We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians’ primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning. Conclusion Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable. Electronic supplementary material The online version of this article (doi:10.1186/s13011-017-0104-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Savic
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia. .,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
| | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Heart of the Campus Building, Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BQ, UK
| | - Victoria Manning
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia.,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia.,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia
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Quinn AE, Stewart MT, Brolin M, Horgan C, Lane NE. Massachusetts Substance Use Disorder Treatment Organizations' Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design. J Psychoactive Drugs 2017; 49:151-159. [PMID: 28350232 PMCID: PMC5701571 DOI: 10.1080/02791072.2017.1301600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations' responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in person June-December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms.
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Affiliation(s)
- Amity E. Quinn
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Maureen T. Stewart
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Mary Brolin
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Constance Horgan
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Nancy E. Lane
- Senior VP, Population Health Management, Vanderbilt University
Medical Center and Assistant Clinical Professor of Psychiatry, Vanderbilt Medical
School, Nashville, TN
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Walker ER, Pratt LA, Schoenborn CA, Druss BG. Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey. Drug Alcohol Depend 2017; 171:31-38. [PMID: 28012429 PMCID: PMC5263065 DOI: 10.1016/j.drugalcdep.2016.11.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/28/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the mortality risks, over 20 years of follow-up in a nationally representative sample, associated with illegal drug use and to describe risk factors for mortality. METHODS We analyzed data from the 1991 National Health Interview Survey, which is a nationally representative household survey in the United States, linked to the National Death Index through 2011. This study included 20,498 adults, aged 18-44 years in 1991, with 1047 subsequent deaths. A composite variable of self-reported lifetime illegal drug use was created (hierarchical categories of heroin, cocaine, hallucinogens/inhalants, and marijuana use). RESULTS Mortality risk was significantly elevated among individuals who reported lifetime use of heroin (HR=2.40, 95% CI: 1.65-3.48) and cocaine (HR=1.27, 95% CI: 1.04-1.55), but not for those who used hallucinogens/inhalants or marijuana, when adjusting for demographic characteristics. Baseline health risk factors (smoking, alcohol use, physical activity, and BMI) explained the greatest amount of this mortality risk. After adjusting for all baseline covariates, the association between heroin or cocaine use and mortality approached significance. In models adjusted for demographics, people who reported lifetime use of heroin or cocaine had an elevated mortality risk due to external causes (poisoning, suicide, homicide, and unintentional injury). People who had used heroin, cocaine, or hallucinogens/inhalants had an elevated mortality risk due to infectious diseases. CONCLUSIONS Heroin and cocaine are associated with considerable excess mortality, particularly due to external causes and infectious diseases. This association can be explained mainly by health risk behaviors.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States.
| | - Laura A Pratt
- Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Hyattsville, MD 20782, United States.
| | - Charlotte A Schoenborn
- Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd., Hyattsville, MD 20782, United States.
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, United States.
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Walker ER, Druss BG. Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the U.S.A. PSYCHOL HEALTH MED 2016; 22:727-735. [PMID: 27593083 DOI: 10.1080/13548506.2016.1227855] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010-2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53-11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67-13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.
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Affiliation(s)
- Elizabeth Reisinger Walker
- a Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Benjamin G Druss
- b Department of Health Policy & Management , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme. Int J Integr Care 2016; 16:7. [PMID: 27616951 PMCID: PMC5015544 DOI: 10.5334/ijic.2457] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. METHODS A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. RESULTS Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. CONCLUSION Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders.
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Padwa H, Teruya C, Tran E, Lovinger K, Antonini VP, Overholt C, Urada D. The Implementation of Integrated Behavioral Health Protocols In Primary Care Settings in Project Care. J Subst Abuse Treat 2016; 62:74-83. [DOI: 10.1016/j.jsat.2015.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/29/2015] [Accepted: 10/22/2015] [Indexed: 11/16/2022]
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Jones EB, Ku L. Sharing a Playbook: Integrated Care in Community Health Centers in the United States. Am J Public Health 2015; 105:2028-34. [PMID: 26270310 PMCID: PMC4566528 DOI: 10.2105/ajph.2015.302710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We investigated basic measures used to assess collaboration between colocated providers and to gauge the extent to which health centers practice integrated care. METHODS We used the Assessment of Behavioral Health Services survey and the 2010 Uniform Data System to explore the elements of integrated care for behavioral health conditions. We used multivariable regression models to examine the correlates of integrated care. RESULTS More than 85% of health centers provided mental health services in 2010, and almost half offered substance use treatment. Health centers commonly reported shared access to information among behavioral health and medical providers and joint care planning. A higher degree of integrated care involving joint case conferences was less common. Health centers without electronic health records and those with lower percentages of total staff composed of behavioral health workers were less likely to provide integrated care. CONCLUSIONS A 2-pronged strategy involving financial incentives and technical assistance to spread best practices might increase integrated care, particularly among health centers that are not maximizing the potential of electronic health records and health centers with low behavioral health staffing levels.
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Affiliation(s)
- Emily B Jones
- Emily B. Jones and Leighton Ku are with the Milken Institute School of Public Health and Health Services, George Washington University, Washington, DC. Emily B. Jones is also with the Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
| | - Leighton Ku
- Emily B. Jones and Leighton Ku are with the Milken Institute School of Public Health and Health Services, George Washington University, Washington, DC. Emily B. Jones is also with the Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC
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Abstract
Non-medical use of opioid analgesics (OAs) has increased in the United States over the past decade, yet there has been little in-depth exploration into the circumstances of initiation of OA misuse. This study is based on qualitative data from five focus groups conducted with individuals who misused OAs in New York City. Participants ( n = 19) were aged between 20 and 47 years. The majority were male ( n = 14) and non-Hispanic White ( n = 12). Three initiate groups were identified: recreational initiates, who typically began misusing OAs in their teens through non-medical sources; medical initiates, who initiated OA use through medical treatment; and experienced opioid users, who initiated OA use through both recreational and medical channels but whose entry into misuse followed a history of heroin use. Findings show heterogeneous patterns of initiation, indicating the need for prevention and intervention strategies to be tailored to particular groups.
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Affiliation(s)
- Alex Harocopos
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Bennett Allen
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
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Urada D, Teruya C, Gelberg L, Rawson R. Integration of substance use disorder services with primary care: health center surveys and qualitative interviews. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:15. [PMID: 24679108 PMCID: PMC3978198 DOI: 10.1186/1747-597x-9-15] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/21/2014] [Indexed: 11/11/2022]
Abstract
Background Each year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services. Methods Primary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n = 18) from these organizations to collect further qualitative information on the barriers and facilitators of integration. Results Compared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity. Conclusions Efforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable.
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Affiliation(s)
- Darren Urada
- Los Angeles Integrated Substance Abuse Programs, University of California, 11075 Santa Monica Blvd Suite 200, Los Angeles, CA 90025, USA.
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