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Engström I, Hansson L, Ali L, Berg J, Ekstedt M, Engström S, Fredriksson MK, Liliemark J, Lytsy P. Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review. BMC Psychiatry 2023; 23:952. [PMID: 38110889 PMCID: PMC10729558 DOI: 10.1186/s12888-023-05440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Continuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI. METHODS Eleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518. RESULTS We identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas. CONCLUSIONS The results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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Affiliation(s)
- Ingemar Engström
- University Health Care Center, Faculty of Medicine and Health, Örebro University, Örebro, SE-701 82, Sweden.
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Berg
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Maja Kärrman Fredriksson
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Jan Liliemark
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Per Lytsy
- SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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Abdelhadi O. The impact of psychological distress on quality of care and access to mental health services in cancer survivors. FRONTIERS IN HEALTH SERVICES 2023; 3:1111677. [PMID: 37405330 PMCID: PMC10316283 DOI: 10.3389/frhs.2023.1111677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023]
Abstract
Introduction Psychological distress is highly prevalent among cancer survivors and significantly impacts their health outcomes. Our study aim is to examine the impact of psychological distress on the quality of care in cancer survivors. Methods We utilized longitudinal panels from the Medical Expenditure Panel Survey data spanning from 2016 to 2019 to estimate the impact of psychological distress on quality of care. We compared a sample of cancer survivors with psychological distress (N = 176) to a matched sample of cancer survivors without psychological distress (N = 2,814). We employed multivariable logistic regression models and Poisson regression models. In all models, we adjusted for age at the survey, sex, race/ethnicity, education, income, insurance, exercise, chronic conditions, body mass index, and smoking status. Descriptive statistics and regression models were performed using STATA software. Results Our findings revealed a higher prevalence of psychological distress among younger survivors, females, individuals with lower incomes, and those with public insurance. Cancer survivors with psychological distress reported more adverse patient experiences compared to those without distress. Specifically, survivors with distress had lower odds of receiving clear explanations of their care (OR: 0.40; 95% CI: 0.17-0.99) and lower odds of feeling respected in expressing their concerns (OR: 0.42; 95% CI: 0.18-0.99) by their healthcare providers. Furthermore, psychological distress was associated with increased healthcare utilization, as evidenced by a higher number of visits (p = 0.02). It also correlated with a decrease in healthcare service ratings (p = 0.01) and the affordability of mental health services (p < 0.01) for cancer survivors. Discussion These findings indicate that psychological distress can significantly impact the delivery of healthcare and the patient experience among cancer survivors. Our study underscores the importance of recognizing and addressing the mental health needs of cancer survivors. It provides insights for healthcare professionals and policymakers to better understand and cater to the mental health needs of this population.
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Hyland CJ, McDowell MJ, Bain PA, Huskamp HA, Busch AB. Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review. J Subst Abuse Treat 2023; 144:108919. [PMID: 36332528 PMCID: PMC10321472 DOI: 10.1016/j.jsat.2022.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/01/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). METHODS The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population ≥ 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. RESULTS The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acamprosate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. CONCLUSIONS The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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Affiliation(s)
- Colby J Hyland
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States of America.
| | - Michal J McDowell
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, United States of America
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States of America.
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America.
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, United States of America; McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, United States of America.
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Chavez LJ, Steelesmith DL, Bridge JA, Fontanella CA. Predictors of substance use disorder treatment initiation and engagement among adolescents enrolled in Medicaid. Subst Abus 2022; 43:1260-1267. [PMID: 35670769 DOI: 10.1080/08897077.2022.2074603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Mark TL, Hinde JM, Barnosky A, Joshi V, Padwa H, Treiman K. Is implementation of ASAM-based addiction treatment assessments associated with improved 30-day retention and substance use? Drug Alcohol Depend 2021; 226:108868. [PMID: 34237614 DOI: 10.1016/j.drugalcdep.2021.108868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/04/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Addiction Medicine (ASAM) criteria were developed to provide a systematic, evidence-based, and transparent approach to addiction treatment assessment and level-of-care recommendations. In 2017, California began a Medicaid demonstration that required that providers in participating counties to adopt ASAM-based intake assessments and level-of-care criteria. We hypothesized that ASAM implementation would increase the proportion of patients retained in addiction treatment and successfully completing their treatment plan. METHODS We implemented a comparative interrupted time series analysis with 407,792 treatment episodes by Medicaid beneficiaries in specialty addiction treatment settings from 2015 to mid-2019. We compared the change in retention rates and successful completion rates in counties that adopted ASAM-based assessments relative to counties that did not adopt ASAM-based assessments and used only clinical judgment for level-of-care decisions. Treatment retention was defined as staying in addiction treatment for at least 30 days. Successful completion of the treatment plan was determined by the patient's clinician. RESULTS After one year, ASAM implementation was associated with a 9% increase in 30-day retention among treatment episodes that started in a residential setting, but no change in retention among episodes starting in outpatient settings. We found no statistically significant association between ASAM adoption and successful treatment completion. CONCLUSIONS Implementation of ASAM-based assessment may lead to improved retention for individuals who begin treatment in residential treatment, which may be encouraging to the many state Medicaid programs that are adopting ASAM-based criteria. More research is needed to clarify the mechanism by which ASAM leads to improved outcomes and to clarify how to maximize the potential benefits of ASAM, such as through patient-centered implementation.
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Affiliation(s)
- Tami L Mark
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States.
| | - Jesse M Hinde
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Alan Barnosky
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, 27709-2194, United States
| | - Vandana Joshi
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Los Angeles, CA, 90095-1759, United States
| | - Katherine Treiman
- RTI International, 6110 Executive Blvd, #900, Rockville, MD, 20852, United States
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Rasmussen LR, Videbech P, Mainz J, Johnsen SP. Gender- and age-related differences in the quality of mental health care among inpatients with unipolar depression: a nationwide study. Nord J Psychiatry 2020; 74:569-576. [PMID: 32401125 DOI: 10.1080/08039488.2020.1764619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The relationship between gender, age and the quality of mental health care among inpatients with depression is unclear. This study examined gender- and age-related differences in the quality of care as reflected by the fulfilment of process performance measures of care among inpatients with unipolar depression in Denmark.Methods: In a nationwide cohort study, 16,858 patients admitted to psychiatric hospital wards for depression between 2011 and 2016 were identified from the Danish Depression Database. Patients were divided according to age (18-39, 40-65, 66-79 and ≥80 years) and stratified by gender. Quality of care was defined as having fulfilled process performance measures of care, reflecting national clinical guideline recommendations. High overall quality of care was defined as having received ≥80% of the processes. The associations were assessed using binomial regressions.Results: With men in the age group 18-39 years serving as the reference, men and women in the age category ≥80 years were more likely to receive higher quality of care with an adjusted relative risk (aRR) of 1.43 [95% confidence interval (CI) = 0.98; 2.10] and 1.30 (95% CI = 0.90; 1.90), respectively. Likewise, for men and women aged 66-79 years, the aRRs as 1.34 (95% CI = 1.07; 1.67) and 1.47 (95% CI = 1.14; 1.90). For men and women aged 40-65, the aRRs was 1.15 (95% CI = 1.00; 1.33) and 1.07 (95% CI = 0.93; 1.24), respectively.Conclusion: Older patients received higher quality of inpatient care for depression, as reflected by a higher proportion of fulfilled guideline supported process measures. In contrast, we found no gender-related differences.
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Affiliation(s)
- Line Ryberg Rasmussen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department for Community Mental Health, University of Haifa, Haifa, Israel
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
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Griffin BA, Ayer L, Pane J, Vegetabile B, Burgette L, McCaffrey D, Coffman DL, Cefalu M, Funk R, Godley MD. Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents. J Subst Abuse Treat 2020; 118:108075. [PMID: 32972649 PMCID: PMC7519172 DOI: 10.1016/j.jsat.2020.108075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
The current study seeks to advance understanding about how to address substance use and co-occurring mental health problems in adolescents. Specifically, we compared the effectiveness of two evidence-based treatment programs (Motivational Enhancement Treatment/Cognitive Behavior Therapy, 5 Sessions [MET/CBT5] and Adolescent Community Reinforcement Approach [A-CRA]) for both substance use and mental health outcomes (i.e., crossover effects). We used statistical methods designed to approximate randomized controlled trials when comparing nonequivalent groups using observational study data. Our methods also included an assessment of the potential impact of omitted variables. We found that after applying balancing weighting to ensure similarity of the baseline samples (given the nonrandomized study design), both groups significantly improved on the two substance use outcomes (days abstinent and percent of youth in recovery) and on the two mental health outcomes (post-traumatic stress disorder (PTSD) symptoms and general emotional problems). Youth in A-CRA were significantly more likely to be in recovery at the 3-month follow-up compared to youth in MET/CBT5, but the size of this effect was very small. Youth receiving MET/CBT5 appeared to show significantly more improvement in the two mental health measures compared to youth in A-CRA, though these effect sizes were also very small. The findings indicate that adolescents with co-occurring substance use and mental health problems improve on both substance use and mental health outcomes with both treatments even though they are not specifically targeting mental health problems.
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Affiliation(s)
| | - Lynsay Ayer
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA.
| | - Joseph Pane
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Lane Burgette
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Donna L Coffman
- Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th floor, Philadelphia, PA 19122, USA.
| | - Matthew Cefalu
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Rod Funk
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
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8
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Vest N, Sox-Harris A, Ilgen M, Humphreys K, Timko C. Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with co-occurring Conditions: A Longitudinal Parallel Growth Mixture Model. Alcohol Clin Exp Res 2020; 44:2570-2578. [PMID: 33104268 DOI: 10.1111/acer.14474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses. METHODS Participants were adults with cooccurring disorders (n = 406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up. RESULTS A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3 months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment. CONCLUSIONS These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.
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Affiliation(s)
- Noel Vest
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA
| | - Alex Sox-Harris
- Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA.,Department of Surgery (AHSH), Stanford University School of Medicine, Stanford, California, USA
| | - Mark Ilgen
- Department of Psychiatry, (MI), University of Michigan, Ann Arbor, Michigan, USA.,VA Center for Clinical Management Research (CCMR), (MI), Ann Arbor, Michigan, USA
| | - Keith Humphreys
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA
| | - Christine Timko
- From the, Department of Psychiatry and Behavioral Sciences (NAV, KH, CT), Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, (AHSH, KH, CT), Palo Alto, California, USA
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9
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Liu J, Storfer-Isser A, Mark TL, Oberlander T, Horgan C, Garnick DW, Scholle SH. Access to and Engagement in Substance Use Disorder Treatment Over Time. Psychiatr Serv 2020; 71:722-725. [PMID: 32089081 DOI: 10.1176/appi.ps.201800461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study evaluated whether access to and engagement in substance use disorder treatment has improved from 2010 to 2016. METHODS Data submitted by commercial and Medicaid health plans, representing over 163 million beneficiaries from 2010 to 2016, were analyzed. RESULTS For commercial plans, identification increased (from 1.0% to 1.6%, p<0.001), the initiation rate declined (from 41.9% to 33.7%, p<0.001), and the engagement rate also declined (from 15.8% to 12.1%, p<0.001). The decline in the initiation and engagement rates could not be explained by the increasing identification rates. For Medicaid plans, the identification rate increased (from 3.3% to 6.7%, p<0.001), and the initiation and engagement rates were unchanged. CONCLUSIONS Although an increasing proportion of health plan members are being identified with substance use disorders, the majority of these individuals are not engaging in treatment.
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Affiliation(s)
- Junqing Liu
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Amy Storfer-Isser
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Tami L Mark
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Tyler Oberlander
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Constance Horgan
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Deborah W Garnick
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
| | - Sarah Hudson Scholle
- National Committee for Quality Assurance, Washington, D.C. (Liu, Storfer-Isser, Oberlander, Scholle); RTI International, Washington, D.C. (Mark); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Garnick)
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Referral to Treatment After Positive Screens for Unhealthy Drug Use in an Outpatient Veterans Administration Setting. J Addict Med 2019; 14:236-243. [PMID: 31567600 DOI: 10.1097/adm.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To measure the rates and predictors of clinician recommendation for follow-up after a positive screen for unhealthy drug use, in a context of mandatory routine screening. To measure response to clinician recommendations and identification of new drug use diagnoses. METHODS Data are from a Veterans Health Administration (VHA) medical center that introduced mandatory routine screening for unhealthy drug use in outpatient primary care and mental health settings, using a validated single question. This study analyzed VHA electronic health records data for patients who screened positive for unhealthy drug use (n = 570) and estimated logistic regression models to identify the predictors of receiving a recommendation for any follow-up and for specialty substance use disorder (SUD) treatment. Bivariate tests were used for other analyses. RESULTS Among patients who screened positive for unhealthy drug use, 66% received no recommendation to return to primary care or another setting from the screening clinician. Further, among the 23% of patients who received a recommendation to visit specialty SUD treatment, only 25% completed the visit within 60 days. Six percent of all positive screens both received a referral to specialty SUD treatment and acted upon it. CONCLUSIONS In the context of mandatory drug use screening using a single item, rates of clinician action and patient receipt of care appeared low. Improved follow-up will require health systems to provide more supports for clinicians and patients at each of the stages from positive screen to attending the follow-up appointment.
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11
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Harris MG, Bharat C, Glantz MD, Sampson NA, Al‐Hamzawi A, Alonso J, Bruffaerts R, Caldas de Almeida JM, Cia AH, Girolamo G, Florescu S, Gureje O, Haro JM, Hinkov H, Karam EG, Karam G, Lee S, Lépine J, Levinson D, Makanjuola V, McGrath J, Mneimneh Z, Navarro‐Mateu F, Piazza M, Posada‐Villa J, Rapsey C, Tachimori H, Have M, Torres Y, Viana MC, Chatterji S, Zaslavsky AM, Kessler RC, Degenhardt L. Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys. Addiction 2019; 114:1446-1459. [PMID: 30835879 PMCID: PMC7408310 DOI: 10.1111/add.14599] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/03/2018] [Accepted: 02/22/2019] [Indexed: 01/29/2023]
Abstract
AIMS To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN Cross-sectional, representative household surveys. SETTING Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
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Affiliation(s)
- Meredith G. Harris
- School of Public HealthThe University of Queensland Herston QLD Australia
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health QLD Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney Australia
| | - Meyer D. Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR)National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) Bethesda MD USA
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ali Al‐Hamzawi
- College of Medicine, Al‐Qadisiya University, Diwaniya Governorate Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM‐Hospital del Mar Medical Research Institute Barcelona Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF) Barcelona Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit Leuven (UPC‐KUL), Campus Gasthuisberg Leuven Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisbon Portugal
| | | | | | - Silvia Florescu
- National School of Public Health, Management and Development Bucharest Romania
| | - Oye Gureje
- Department of PsychiatryUniversity College Hospital Ibadan Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat Barcelona Spain
| | - Hristo Hinkov
- National Center of Public Health and Analyses Sofia Bulgaria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand University Beirut Lebanon
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center Beirut Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center, Balamand University, Faculty of Medicine Beirut Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Sing Lee
- Department of PsychiatryChinese University of Hong Kong Tai Po Hong Kong
| | - Jean‐Pierre Lépine
- Hôpital Lariboisière‐Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes‐Paris Diderot;INSERM UMR‐S 1144 Paris France
| | | | - Victor Makanjuola
- Department of Psychiatry, College of MedicineUniversity of Ibadan; University College Hospital Ibadan Nigeria
| | - John McGrath
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health Wacol QLD Australia
- Queensland Brain Institute, University of Queensland St Lucia QLD Australia
- National Centre for Register‐Based ResearchAarhus University Aarhus Denmark
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social ResearchUniversity of Michigan Ann Arbor MI USA
| | - Fernando Navarro‐Mateu
- UDIF‐SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB‐Arrixaca, CIBERESP‐ Murcia Murcia Spain
| | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences Bogota Colombia
| | - Charlene Rapsey
- Department of Psychological MedicineUniversity of Otago, Dunedin School of Medicine Otago New Zealand
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry Kodaira Tokyo Japan
| | - Margreet Have
- Trimbos‐Instituutthe Netherlands Institute of Mental Health and Addiction Utrecht the Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES University Medellin Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito Santo Vitoria Brazil
| | - Somnath Chatterji
- Department of Information, Evidence and ResearchWorld Health Organization Geneva Switzerland
| | - Alan M. Zaslavsky
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney NSW Australia
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12
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Kline-Simon AH, Stumbo SP, Campbell CI, Binswanger IA, Weisner C, Haller IV, Hechter RC, Ahmedani BK, Lapham GT, Loree AM, Sterling SA, Yarborough BJH. Patient characteristics associated with treatment initiation and engagement among individuals diagnosed with alcohol and other drug use disorders in emergency department and primary care settings. Subst Abus 2019; 40:278-284. [PMID: 30702983 DOI: 10.1080/08897077.2018.1547812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however, it is unknown whether characteristics of patients who initiate and engage in treatment differ between these settings. Methods: Patients identified with an AOD disorder in ED or PC settings were drawn from a larger study that examined Healthcare Effectiveness Data and Information Set (HEDIS) AOD treatment initiation and engagement measures across 7 health systems using electronic health record data (n = 54,321). Multivariable generalized linear models, with a logit link, clustered on health system, were used to model patient factors associated with initiation and engagement in treatment, between and within each setting. Results: Patients identified in the ED had higher odds of initiating treatment than those identified in PC (adjusted odds ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.73-2.07), with no difference in engagement between the settings. Among those identified in the ED, compared with patients aged 18-29, older patients had higher odds of treatment initiation (age 30-49: aOR = 1.25, 95% CI = 1.12-1.40; age 50-64: aOR = 1.42, 95% CI = 1.26-1.60; age 65+: aOR = 1.27, 95% CI = 1.08-1.49). However, among those identified in PC, compared with patients aged 18-29, older patients were less likely to initiate (age 30-49: aOR = 0.81, 95% CI = 0.71-0.94; age 50-64: aOR = 0.68, 95% CI = 0.58-0.78; age 65+: aOR = 0.47, 95% CI = 0.40-0.56). Women identified in ED had lower odds of initiating treatment (aOR = 0.80, 95% CI = 0.72-0.88), whereas sex was not associated with treatment initiation in PC. In both settings, patients aged 65+ had lower odds of engaging compared with patients aged 18-29 (ED: aOR = 0.61, 95% CI = 0.38-0.98; PC: aOR = 0.42, 95% CI = 0.26-0.68). Conclusion: Initiation and engagement in treatment differed by sex and age depending on identification setting. This information could inform tailoring of future AOD interventions.
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Affiliation(s)
- Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Scott P Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, Detroit, Minnesota, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Amy M Loree
- Center for Health Policy and Health Services Research and Behavioral Health Services, Henry Ford Health System, Detroit, Minnesota, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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13
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Snyder SM, Morse SA, Bride BE. A comparison of 2013 and 2017 baseline characteristics among treatment-seeking patients who used opioids with co-occurring disorders. J Subst Abuse Treat 2019; 99:134-138. [PMID: 30797385 DOI: 10.1016/j.jsat.2019.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/29/2022]
Abstract
The opioid epidemic is a public health crisis that has captured the attention of the media and political leaders, but how much do we know about its implications for substance use disorder treatment providers? This study is the first to investigate the differing baseline characteristics among patients with co-occurring disorders who used opioids and entered residential treatment in 2013 and 2017. Our sample consisted of 1413 unique adults who reported using opioids upon admission to integrated residential treatment for co-occurring substance use and mental health disorders during 2013 (n = 718) and 2017 (n = 695). Opioid use was defined as self-reported use of heroin or illicit use of prescription opioids, including methadone, during the month prior to admission into the treatment program. All study participants completed an admission interview that included the Addiction Severity Index (ASI). The 2017 cohort demonstrated higher severity than the 2013 cohort on the employment, psychiatric, and alcohol and drug ASI composite scores. A comparison of days per month that the cohorts used various substances also reveals this trend, with the following comparisons listing the 2017 cohort data first, and the 2013 cohort data second: (1) alcohol (8.6 days vs. 7.0 days); (2) cocaine (4.1 days vs. 2.2 days); (3) amphetamines (6.2 days vs. 3.6 days); and (4) polysubstance use in one day (16.6 days vs. 11.6 days). The 2017 cohort was also intoxicated from alcohol more days per month (7.2 days vs. 5.1 days). However, the 2017 cohort reported fewer days using prescription opioids (9.9 days vs. 12.4 days). A higher proportion of the 2017 cohort reported (1) depression (74% vs. 68%); (2) anxiety (88% vs. 84%); (3) hallucinations (14% vs 8%); and (4) and suicidal ideation (22% vs. 17%).
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Affiliation(s)
- Susan M Snyder
- School of Social Work, Georgia State University, 55 Park Place, Rm. 575, Atlanta, GA 30303, United States of America.
| | - Siobhan A Morse
- Universal Health Services, Inc., 1000 Health Park Drive, Building 3, Suite 400, Brentwood, TN 37027, United States of America.
| | - Brian E Bride
- School of Social Work, Georgia State University, 55 Park Place, Rm. 552, Atlanta, GA 30303, United States of America.
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14
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Loree AM, Yeh HH, Satre DD, Kline-Simon AH, Yarborough BJH, Haller IV, Campbell CI, Lapham GT, Hechter RC, Binswanger IA, Weisner C, Ahmedani BK. Psychiatric comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) measures of alcohol and other drug treatment initiation and engagement across 7 health care systems. Subst Abus 2019; 40:311-317. [PMID: 30681938 DOI: 10.1080/08897077.2018.1545727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Psychiatric comorbidity is common among patients with alcohol and other drug (AOD) use disorders. To better understand how psychiatric comorbidity influences AOD treatment access in health care systems, the present study examined treatment initiation and engagement among a large, diverse sample of patients with comorbid psychiatric and AOD use disorders. Methods: This study utilized data from a multisite observational study examining Healthcare Effectiveness Data and Information Set (HEDIS) measures of initiation and engagement in treatment (IET) among patients with AOD use disorders from 7 health care systems. Participants were aged 18 or older with at least 1 AOD index diagnosis between October 1, 2014, and August 15, 2015. Data elements extracted from electronic health records and insurance claims data included patient demographic characteristics, ICD-9 (International Classification of Diseases, Ninth Revision) diagnostic codes, and procedure codes. Descriptive analyses and multivariate logistic regression models were used to examine the relationship between patient-level factors and IET measures. Results: Across health care systems, out of a total of 86,565 patients who had at least 1 AOD index diagnosis during the study period, 66.2% (n = 57,335) patients also had a comorbid psychiatric disorder. Among patients with a comorbid psychiatric disorder, 34.9% (n = 19,998) initiated AOD treatment, and of those, 10.3% (n = 2,060) engaged in treatment. After adjusting for age, sex, and race/ethnicity, patients with comorbid psychiatric disorders were more likely to initiate (odds ratio [OR] = 3.20, 95% confidence interval [CI] = 3.08, 3.32) but no more likely to engage (OR = 0.56, 95% CI = 0.51, 0.61) in AOD treatment, compared with those without a comorbid psychiatric disorder. Conclusions: Findings suggest that identification of comorbid psychiatric disorders may increase initiation in AOD treatment. However, innovative efforts are needed to enhance treatment engagement both generally and especially for individuals without diagnosed psychiatric conditions.
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Affiliation(s)
- Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, Colorado, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, Colorado, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, Colorado, USA
| | | | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, Colorado, USA
| | - Gwen T Lapham
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Colorado Permanente Medical Group, Aurora, Colorado, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, Colorado, USA.,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, Colorado, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
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15
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Abstract
PURPOSE OF REVIEW Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. RECENT FINDINGS Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
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16
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Jones AL, Mor MK, Haas GL, Gordon AJ, Cashy JP, Schaefer JH, Hausmann LRM. The Role of Primary Care Experiences in Obtaining Treatment for Depression. J Gen Intern Med 2018; 33:1366-1373. [PMID: 29948804 PMCID: PMC6082202 DOI: 10.1007/s11606-018-4522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. OBJECTIVE In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. DESIGN AND PARTICIPANTS We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. MAIN MEASURES We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. KEY RESULTS Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. CONCLUSIONS In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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17
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Lee MT, Acevedo A, Garnick DW, Horgan CM, Panas L, Ritter GA, Campbell KM. Impact of Agency Receipt of Incentives and Reminders on Engagement and Continuity of Care for Clients With Co-Occurring Disorders. Psychiatr Serv 2018; 69:804-811. [PMID: 29695226 PMCID: PMC6193487 DOI: 10.1176/appi.ps.201700465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined whether having co-occurring substance use and mental disorders influenced treatment engagement or continuity of care and whether offering financial incentives, client-specific electronic reminders, or a combination to treatment agencies improved treatment engagement and continuity of care among clients with co-occurring disorders. METHODS The study used a randomized cluster design to assign agencies (N=196) providing publicly funded substance use disorder treatment in Washington State to a research arm: incentives only, reminders only, incentives and reminders, and a control condition. Data were analyzed for 76,044 outpatient, 32,797 residential, and 39,006 detoxification admissions from Washington's treatment data system. Multilevel logistic regressions were conducted, with clients nested within agencies, to examine the effect of the interventions on treatment engagement and continuity of care. RESULTS Compared with clients with a substance use disorder only, clients with co-occurring disorders were less likely to engage in outpatient treatment or have continuity of care after discharge from residential treatment, but they were more likely to have continuity of care after discharge from detoxification. The interventions did not influence treatment engagement or continuity of care, except the reminders had a positive impact on continuity of care after residential treatment among clients with co-occurring disorders. CONCLUSIONS In general, the interventions did not result in improved treatment engagement or continuity of care. The limited number of significant results supporting the influence of incentives and alerts on treatment engagement and continuity of care add to the mixed findings reported by previous research. Multiple interventions may be needed for performance improvement.
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Affiliation(s)
- Margaret T Lee
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Andrea Acevedo
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Deborah W Garnick
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Constance M Horgan
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Lee Panas
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Grant A Ritter
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
| | - Kevin M Campbell
- With the exception of Dr. Campbell, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Acevedo is also with the Department of Community Health, Tufts University, Medford, Massachusetts. Dr. Campbell is with the Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, Olympia
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18
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Williams AR, Nunes EV, Bisaga A, Pincus HA, Johnson KA, Campbell AN, Remien RH, Crystal S, Friedmann PD, Levin FR, Olfson M. Developing an opioid use disorder treatment cascade: A review of quality measures. J Subst Abuse Treat 2018; 91:57-68. [PMID: 29910015 DOI: 10.1016/j.jsat.2018.06.001] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 06/01/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite increasing opioid overdose mortality, problems persist in the availability and quality of treatment for opioid use disorder (OUD). Three FDA-approved medications (methadone, buprenorphine, and naltrexone) have high quality evidence supporting their use, but most individuals with OUD do not receive them and many experience relapse following care episodes. Developing and organizing quality measures under a unified framework such as a Cascade of Care could improve system level practice and treatment outcomes. In this context, a review was performed of existing quality measures relevant to the treatment of OUD and the literature assessing the utility of these measures in community practice. METHODS Systematic searches of two national quality measure clearinghouses (National Quality Forum and Agency for Healthcare Research and Quality) were performed for measures that can be applied to the treatment of OUD. Measures were categorized as structural, process, or outcome measures. Second stage searches were then performed within Ovid/Medline focused on published studies investigating the feasibility, reliability, and validity of identified measures, predictors of their satisfaction, and related clinical outcomes. RESULTS Seven quality measures were identified that are applicable to the treatment of OUD. All seven were process measures that assess patterns of service delivery. One recently approved measure addresses retention in medication-assisted treatment for patients with OUD. Twenty-nine published studies were identified that evaluate the quality measures, primarily focused on initiation and engagement in care for addiction treatment generally. Most measures and related studies do not specifically incorporate the evidence base for the treatment of OUD or assess patient level outcomes such as overdose. CONCLUSION Despite considerable progress, gaps exist in quality measures for OUD treatment. Development of a unified quality measurement framework such as an OUD Treatment Cascade will require further elaboration and refinement of existing measures across populations and settings. Such a framework could form the basis for applying strategies at clinical, organizational, and policy levels to expand access to quality care and reduce opioid-related mortality.
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Affiliation(s)
- Arthur Robin Williams
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States.
| | - Edward V Nunes
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Adam Bisaga
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Harold A Pincus
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States; New York-Presbyterian Hospital, United States
| | - Kimberly A Johnson
- University of South Florida Department of Mental Health Law and Policy, United States
| | - Aimee N Campbell
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Remien H Remien
- HIV Center for Clinical and Behavioral Studies, Columbia University, United States
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers, United States
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts-Baystate and Baystate Health, United States
| | - Frances R Levin
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
| | - Mark Olfson
- Columbia University Department of Psychiatry, United States; New York State Psychiatric Institute, United States
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19
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Abstract
: Initiation and engagement (IET), a process quality indicator for the treatment for substance use disorders (SUDs), has been associated with better treatment outcomes and has been part of the Healthcare Effectiveness Data and Information Set for over a decade. However, nationally, IET rates tend to be low and not improving. Integration may be a promising way to improve IET and quality of care, as suggested by the findings. To guarantee that integration is a truly effective mechanism for improving patient engagement and quality would likely require providing clinicians and other primary care providers with additional support and training on SUDs and treatment, and ensure that everyone, regardless of demographic characteristics, can equally benefit from these system level changes.
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20
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Paddock SM, Hepner KA, Hudson T, Ounpraseuth S, Schrader AM, Sullivan G, Watkins KE. Association Between Process-Based Quality Indicators and Mortality for Patients With Substance Use Disorders. J Stud Alcohol Drugs 2018; 78:588-596. [PMID: 28728641 DOI: 10.15288/jsad.2017.78.588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Substance use disorders (SUDs) are associated with elevated rates of mortality. Little is known about whether receiving appropriate care is associated with lower mortality for patients with SUDs. This study examined the association between the receipt of care for SUDs and subsequent 12- and 24-month mortality. METHOD This was a retrospective cohort study of veterans who received care for SUDs paid for by the Veterans Health Administration during October 2006- September 2007 (n = 339,966). Logistic regressions were used to examine the association between quality indicators measuring receipt of care and mortality while controlling for patient characteristics and facility service area. RESULTS There were four quality indicators: SUD treatment initiation, SUD treatment engagement, SUD-related psychosocial treatment, and SUD-related psychotherapy. Outcomes measured were mortality 12 and 24 months after the end of the observation period, through September 2009. Receipt of indicated care ranged from 26.5% to 58.6%, and 12- and 24-month mortality rates were 3% and 6%, respectively. Adjusted odds ratios [95% CI] of 12-month mortality by indicator were: initiation, 0.86 [0.79, 0.93]; engagement, 0.65 [0.58, 0.74]; psychosocial treatment, 0.88 [0.84, 0.92]; and psychotherapy, 0.84 [0.79, 0.89]. For the 24-month mortality outcome, adjusted odds ratios were: initiation, 0.88 [0.84, 0.93]; engagement, 0.78 [0.71, 0.85]; psychosocial treatment, 0.91 [0.88, 0.94]; and psychotherapy, 0.87 [0.83, 0.91]. Results were similar when controlling for facility service area. CONCLUSIONS Receiving appropriate care is associated with lower mortality for patients with SUDs. Significant overall and within-facility service area associations of quality indicators and mortality support their use in encouraging providers to deliver the indicated care. These indicators should be prioritized above others lacking comparably strong process-outcome associations.
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Affiliation(s)
| | | | - Teresa Hudson
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Amy M Schrader
- University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Veterans Affairs Center for Mental Healthcare and Outcomes Research, Little Rock, Arkansas
| | - Greer Sullivan
- University of California Riverside School of Medicine, Riverside, California
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21
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Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O'Brien RW, Tomoyasu N, Pincus HA. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry 2018; 17:30-38. [PMID: 29352529 PMCID: PMC5775149 DOI: 10.1002/wps.20482] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.
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Affiliation(s)
- Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathryn Beck
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brigitta Spaeth-Rublee
- Department of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, USA
| | - Parashar Ramanuj
- RAND Europe, Cambridge, UK
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Robert W O'Brien
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Naomi Tomoyasu
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Harold Alan Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York-Presbyterian Hospital, New York, NY, USA
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22
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Simmons MM, Fincke BG, Drainoni ML, Kim B, Byrne T, Smelson D, Casey K, Ellison ML, Visher C, Blue-Howells J, McInnes DK. A two-state comparative implementation of peer-support intervention to link veterans to health-related services after incarceration: a study protocol. BMC Health Serv Res 2017; 17:647. [PMID: 28899394 PMCID: PMC5596492 DOI: 10.1186/s12913-017-2572-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 600,000 persons are released from prison annually in the United States. Relatively few receive sufficient re-entry services and are at risk for unemployment, homelessness, poverty, substance abuse relapse and recidivism. Persons leaving prison who have a mental illness and/or a substance use disorder are particularly challenged. This project aims to create a peer mentor program to extend the reach and effectiveness of reentry services provided by the Department of Veterans' Affairs (VA). We will implement a peer support for reentry veterans sequentially in two states. Our outcome measures are 1) fidelity of the intervention, 2) linkage to VA health care and, 3) continued engagement in health care. The aims for this project are as follows: (1) Conduct contextual analysis to identify VA and community reentry resources, and describe how reentry veterans use them. (2) Implement peer-support, in one state, to link reentry veterans to Veterans' Health Administration (VHA) primary care, mental health, and SUD services. (3) Port the peer-support intervention to another, geographically, and contextually different state. DESIGN This intervention involves a 2-state sequential implementation study (Massachusetts, followed by Pennsylvania) using a Facilitation Implementation strategy. We will conduct formative and summative analyses, including assessment of fidelity, and a matched comparison group to evaluate the intervention's outcomes of veteran linkage and engagement in VHA health care (using health care utilization measures). The study proceeds in 3 phases. DISCUSSION We anticipate that a peer support program will be effective at improving the reentry process for veterans, particularly in linking them to health, mental health, and SUD services and helping them to stay engaged in those services. It will fill a gap by providing veterans with access to a trusted individual, who understands their experience as a veteran and who has experienced justice involvement. The outputs from this project, including training materials, peer guidebooks, and implementation strategies can be adapted by other states and regions that wish to enhance services for veterans (or other populations) leaving incarceration. A larger cluster-randomized implementation-effectiveness study is planned. TRIAL REGISTRATION This protocol is registered with clinicaltrials.gov on November 4, 2016 and was assigned the number NCT02964897 .
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Affiliation(s)
- Molly M Simmons
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA. .,Boston University School of Public Health, Boston, USA.
| | - Benjamin G Fincke
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
| | - Mari-Lynn Drainoni
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bo Kim
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Harvard Medical School, Boston, USA
| | - Tom Byrne
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Social Work, Boston, USA
| | - David Smelson
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,VA National Center on Homelessness among Veterans, Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | - Kevin Casey
- VA New England Healthcare System, Bedford, USA
| | - Marsha L Ellison
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,University of Massachusetts Medical School, Worcester, USA
| | | | | | - D Keith McInnes
- VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, USA.,Boston University School of Public Health, Boston, USA
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23
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Watkins KE, Paddock SM, Hudson TJ, Ounpraseuth S, Schrader AM, Hepner KA, Stein BD. Association between process measures and mortality in individuals with opioid use disorders. Drug Alcohol Depend 2017; 177:307-314. [PMID: 28662975 PMCID: PMC5557034 DOI: 10.1016/j.drugalcdep.2017.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/20/2017] [Accepted: 03/26/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Individuals with opioid use disorders have high rates of mortality relative to the general population. The relationship between treatment process and mortality is unknown. AIM To examine the association between 7 process measures and 12- and 24-month mortality. METHODS Retrospective cohort study of patients with opioid use disorders who received care from the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 7 patient-level process measures, while risk-adjusting for patient characteristics. Process measures included quarterly physician visits, any opioid use disorder pharmacotherapy, continuous pharmacotherapy, psychosocial treatment, Hepatitis B/C and HIV screening, and no prescriptions for benzodiazepines or opioids. We conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. RESULTS Among individuals with opioid use disorders, not being prescribed opioids or benzodiazepines, receipt of any psychosocial treatment and quarterly physician visits were significantly associated with lower mortality at both 12 and 24 months, but Hepatitis and HIV screening, and measures related to opioid use disorder pharmacotherapy were not. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of the confounder, to render these findings non-significant. CONCLUSIONS AND RELEVANCE This is the first study to show an association between process measures and mortality in patients with opioid use disorders and provides initial evidence for their use as quality measures.
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Affiliation(s)
- Katherine E. Watkins
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA,Corresponding author: Katherine E. Watkins, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, USA 90407-2138, ; (310) 393-0411, x6509
| | - Susan M. Paddock
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Teresa J. Hudson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR, 72205, USA
| | - Songthip Ounpraseuth
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA; College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA.
| | - Amy M. Schrader
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Ft. Roots Dr., Bldg. 58, North Little Rock, AR, 72214, USA,College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., #820, Little Rock, AR, 72205, USA
| | | | - Bradley D. Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA,University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA, 15261, USA
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24
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Smylie J, Cywink M. Missing and murdered Indigenous women: Working with families to prepare for the National Inquiry. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2016; 107:e342-e346. [PMID: 28026695 PMCID: PMC6972438 DOI: 10.17269/cjph.107.5969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/24/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
No abstract available.
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Affiliation(s)
- Janet Smylie
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON; Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
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