1
|
Raver E, Retchin SM, Li Y, Carlo AD, Xu WY. Rural-urban differences in out-of-network treatment initiation and engagement rates for substance use disorders. Health Serv Res 2024; 59:e14299. [PMID: 38456488 PMCID: PMC11366955 DOI: 10.1111/1475-6773.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To examine rural-urban disparities in substance use disorder treatment access and continuation. DATA SOURCES AND STUDY SETTING We analyzed a 2016-2018 U.S. national secondary dataset of commercial insurance claims. STUDY DESIGN This cross-sectional study examined individuals with a new episode of opioid, alcohol, or other drug use disorders. Treatment initiation and engagement rates, and rates of using out-of-network providers for these services, were compared between rural and urban patients. DATA COLLECTION We included individuals 18-64 years old with continuous employer-sponsored insurance. PRINCIPAL FINDINGS Patients in rural settings experienced lower treatment initiation rates for alcohol (36.6% vs. 38.0%, p < 0.001), opioid (41.2% vs. 44.2%, p < 0.001), and other drug (37.7% vs. 40.1%, p < 0.001) use disorders, relative to those in urban areas. Similarly, rural patients had lower treatment engagement rates for alcohol (15.1% vs. 17.3%, p < 0.001), opioid (21.0% vs. 22.6%, p < 0.001), and other drug (15.5% vs. 17.5%, p < 0.001) use disorders. Rural patients had higher out-of-network rates for treatment initiation for other drug use disorders (20.4% vs. 17.2%, p < 0.001), and for treatment engagement for alcohol (27.6% vs. 25.2%, p = 0.006) and other drug (36.1% vs. 31.1%, p < 0.001) use disorders. CONCLUSIONS These findings indicate that individuals with substance use disorders in rural areas have lower rates of initial and ongoing treatment, and are more likely to seek care out-of-network.
Collapse
Affiliation(s)
- Eli Raver
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| | - Sheldon M. Retchin
- Division of General Internal Medicine, Department of Internal Medicine, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Yiting Li
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Present address:
Nationwide Children's HospitalColumbusOhioUSA
| | - Andrew D. Carlo
- Meadows Mental Health Policy InstituteNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Wendy Y. Xu
- Division of Health Services Management and Policy, College of Public HealthThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
2
|
Shrestha S, Lindstrom MR, Harris D, Rock P, Srinivasan S, Pustz JC, Bayly R, Stopka TJ. Spatial access to buprenorphine-waivered prescribers in the HEALing communities study: Enhanced 2-step floating catchment area analyses in Massachusetts, Ohio, and Kentucky. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209077. [PMID: 37211155 PMCID: PMC10330859 DOI: 10.1016/j.josat.2023.209077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/08/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The opioid overdose epidemic continues to impact a large swath of the population in the US. Medications for opioid use disorders (MOUD) are an effective resource to combat the epidemic; however, there is limited research on MOUD treatment access that accounts for both supply of and demand for services. We aimed to examine access to buprenorphine prescribers in the HEALing Communities Study (HCS) Wave 2 communities in Massachusetts, Ohio, and Kentucky during 2021, and the association between buprenorphine access and opioid-related incidents, specifically fatal overdoses and opioid-related responses by emergency medical services (EMS). METHODS We calculated Enhanced 2-Step Floating Catchment Area (E2SFCA) accessibility indices for each state, as well as Wave 2 communities in each state, based on the location of providers (buprenorphine-waivered clinicians from the US Drug Enforcement Agency Active Registrants database), population-weighted centroids at the census block group level, and catchment areas defined by the state or community's average commute time. In advance of intervention initiation, we quantified the opioid-related risk environment of communities. We assessed gaps in services by using bivariate Local Moran's I analysis, incorporating accessibility indices and opioid-related incident data. RESULTS Massachusetts Wave 2 HCS communities had the highest rates of buprenorphine prescribers per 1000 patients (median: 165.8) compared to Kentucky (38.8) and Ohio (40.1). While urban centers in all three states had higher E2SFCA index scores compared to rural communities, we observed that suburban communities often had limited access. Through bivariate Local Moran's I analysis, we identified numerous locations with low buprenorphine access surrounded by high opioid-related incidents, particularly in communities that surrounded Boston, Massachusetts; Columbus, Ohio; and Louisville, Kentucky. CONCLUSION Rural communities demonstrated a great need for additional access to buprenorphine prescribers. However, policymakers should also direct attention toward suburban communities that have experienced significant increases in opioid-related incidents.
Collapse
Affiliation(s)
- Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Megan R Lindstrom
- Department of Geography, Ohio State University, 154 North Oval Mall, Columbus, OH 43210, United States of America
| | - Daniel Harris
- Department of Pharmacy Practice and Science, College of Pharmacy, Lee T. Todd Building, University of Kentucky, Lexington, KY 40506, United States of America; Institute of Pharmaceutical Outcomes and Policy, College of Pharmacy, Lee T. Todd Building, University of Kentucky, Lexington, KY 40506, United States of America
| | - Peter Rock
- Institute for Biomedical Informatics, College of Medicine, University of Kentucky, Lexington, KY 40506, United States of America
| | - Sumeeta Srinivasan
- Department of Urban and Environmental Policy and Planning, Tufts University Graduate School of Arts and Sciences, 97 Talbot Ave., Medford, MA, United States of America
| | - Jennifer C Pustz
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Ric Bayly
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave., Boston, MA 02111, United States of America; Clinical and Translational Sciences Institute, Tufts University School of Medicine, 35 Kneeland St., Boston, MA 02111, United States of America; Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, United States of America; Department Urban and Environmental Policy and Planning, Tufts University, 97 Talbot Ave, Medford, MA, United States of America.
| |
Collapse
|
3
|
P Hong PY, Kim SH, Marley J, Park JH. Transforming Impossible into Possible (TIP) for SUD recovery: A promising practice innovation to combat the opioid crisis. SOCIAL WORK IN HEALTH CARE 2021; 60:509-528. [PMID: 34414853 DOI: 10.1080/00981389.2021.1958127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine the psychological self-sufficiency (PSS) process among low-income individuals participating in the Transforming Impossible into Possible (TIP) program and explore the implications of TIP as a SUD recovery intervention. A sample of 622 individuals from 9 local job training programs in a large Midwestern city was used to examine the group differences in substance abuse barrier and employment hope as they relates to economic self-sufficiency (ESS). Individuals in the TIP program (n = 315) had statistically significant path coefficients between substance abuse barriers, employment hope and ESS while the non-TIP counterpart (n = 307) showed a significant path only between employment hope and ESS. Also, the time difference score in substance abuse barrier and ESS was greater for the TIP group compared to the non-TIP comparison group. Results provide implications for social work practice among persons with SUDs. While the traditional employment programs focused only on the interview and job skills, TIP allowed participants to discover their resources to address the inner obstacles that have been holding them back. TIP could serve as a promising model to treat SUDs and support the recovery process.
Collapse
Affiliation(s)
| | - Suk-Hee Kim
- School of Social Work, Northern Kentucky University, Highland Heights, KY, USA
| | - James Marley
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | - Jang Ho Park
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| |
Collapse
|
4
|
Schwartz AE, Rogers ES, Russinova Z. Predictors of community-based employment for young adults with intellectual disability and co-occurring mental health conditions. Disabil Rehabil 2021; 44:1609-1618. [PMID: 34011223 DOI: 10.1080/09638288.2021.1907457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To identify predictors of community-based employment and employment quality for young adults ages 23-30 with intellectual disability and co-occurring mental health conditions (YA-ID-MH). METHODS We conducted secondary analysis of the 2017-2018 National Core Indicators® (NCI®) In-Person Survey. The NCI® survey was conducted in 35 states and Washington DC. Participants: YA with ID, ages 23-30 who had complete data. We conducted multiple regression analyses to examine demographic and environmental predictors of community-based employment, in addition to employment quality indicators: hourly wages, hours worked, and job duration. We also descriptively examined job satisfaction. RESULTS YA-ID-MH were somewhat less likely to be employed per record review and self-report than YA with ID only, but these findings did not reach statistical significance. On average, YA with ID only had higher hourly wages and worked more hours than those with ID-MH, but there were no significant differences in job duration. For YA-ID-MH, predictors of employment included gender, race, level of ID, and residential setting. Multiple demographic and environmental factors predicted employment quality. CONCLUSIONS YA-ID-MH experience employment disparities compared to YA with ID only. Service providers should specifically attend to those at the highest risk of unemployment/low quality employment.IMPLICATIONS FOR REHABILITATIONYoung adults with intellectual/developmental disabilities and co-occurring mental health conditions (ID-MH) experience employment disparities.Young adults with ID-MH who are non-white and female may have particularly low employment rates and employment quality.Societal-level interventions to address racial and gender-based bias may support individuals with ID-MH to acquire and maintain jobs by addressing disparities in social networks/social capital and ensuring equitable service provision and supports for those at the highest risk for unemployment.Policy makers should consider additional funding for employment services for transition-age youth with ID-MH, particularly those from marginalized populations.
Collapse
Affiliation(s)
- Ariel E Schwartz
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - E Sally Rogers
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| |
Collapse
|
5
|
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.
Collapse
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)
| |
Collapse
|
6
|
Race/Ethnicity, Community of Residence, and DUI Arrest After Beginning Treatment for an Alcohol Use Disorder. J Behav Health Serv Res 2019; 47:201-215. [PMID: 31452026 DOI: 10.1007/s11414-019-09672-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to examine whether racial/ethnic disparities in post-treatment arrests for driving under the influence (DUI) exist among clients receiving outpatient treatment for an alcohol use disorder (AUD) and to assess whether community characteristics were associated with this outcome. The sample included adults with an AUD entering publicly funded outpatient treatment in Washington State in 2012. Treatment data were linked with criminal justice and US Census data. Multilevel time-to-event analysis was employed to answer the research questions. Key independent variables included client race/ethnicity, community-level economic disadvantage, and racial/ethnic composition of the community. Latino clients and clients residing in communities with a higher proportion of Black residents had higher hazards of a DUI arrest post-treatment admission. Future research should examine whether disparities in DUI arrests are related to differences in treatment effectiveness or other factors (e.g., inequities in law enforcement) so that these disparities can be addressed.
Collapse
|
7
|
Acevedo A, Miles J, Panas L, Ritter G, Campbell K, Garnick D. Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place. J Stud Alcohol Drugs 2019; 80:220-229. [PMID: 31014467 PMCID: PMC6489550 DOI: 10.15288/jsad.2019.80.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/01/2018] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE This study examined whether racial/ethnic disparities exist in posttreatment arrests and assessed the extent to which community characteristics account for such disparities. METHOD Administrative data on clients (N = 10,529) receiving publicly funded services in Washington State were linked with criminal justice and census data. Multilevel survival models were used for two outcomes measuring time (in days) to any arrest and to any substance-related arrest. Community characteristics included a factor measuring community economic disadvantage and the proportions of residents in the client's residential census tract who were Black, Latino, or American Indian/Alaskan Native. RESULTS When we controlled for age, sex, substance use, referral source, and prior criminal justice involvement, Black clients (hazard ratio [HR] = 1.47, p < .01) had a higher hazard of any arrest compared with White clients, and Black (HR = 1.27, p < .05) and Latino (HR = 1.20, p < .05) clients had a higher hazard of a substance-related arrest. Clients living in census tracts with a higher proportion of Black residents had a higher hazard of any arrest (HR = 1.25, p < .01) as well as substance-related arrests (HR = 1.39, p < .01). Community characteristics did not account for racial/ethnic disparities in arrests but provided an independent effect. CONCLUSIONS Disparities in arrest outcomes are influenced by both individual- and community-level factors; therefore, strategies for reducing disparities in this treatment outcome should be implemented at both levels.
Collapse
Affiliation(s)
- Andrea Acevedo
- Department of Community Health, Tufts University, Medford, Massachusetts
| | - Jennifer Miles
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Grant Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kevin Campbell
- Research and Data Analysis, Washington State Department of Social and Health Services, Olympia, Washington
| | - Deborah Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| |
Collapse
|
8
|
Acevedo A, Miles J, Panas L, Ritter G, Campbell K, Garnick D. Disparities in Criminal Justice Outcomes After Beginning Treatment for Substance Use Disorders: The Influence of Race/Ethnicity and Place. J Stud Alcohol Drugs 2019; 80:220-229. [PMID: 31014467 PMCID: PMC6489550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/01/2018] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE This study examined whether racial/ethnic disparities exist in posttreatment arrests and assessed the extent to which community characteristics account for such disparities. METHOD Administrative data on clients (N = 10,529) receiving publicly funded services in Washington State were linked with criminal justice and census data. Multilevel survival models were used for two outcomes measuring time (in days) to any arrest and to any substance-related arrest. Community characteristics included a factor measuring community economic disadvantage and the proportions of residents in the client's residential census tract who were Black, Latino, or American Indian/Alaskan Native. RESULTS When we controlled for age, sex, substance use, referral source, and prior criminal justice involvement, Black clients (hazard ratio [HR] = 1.47, p < .01) had a higher hazard of any arrest compared with White clients, and Black (HR = 1.27, p < .05) and Latino (HR = 1.20, p < .05) clients had a higher hazard of a substance-related arrest. Clients living in census tracts with a higher proportion of Black residents had a higher hazard of any arrest (HR = 1.25, p < .01) as well as substance-related arrests (HR = 1.39, p < .01). Community characteristics did not account for racial/ethnic disparities in arrests but provided an independent effect. CONCLUSIONS Disparities in arrest outcomes are influenced by both individual- and community-level factors; therefore, strategies for reducing disparities in this treatment outcome should be implemented at both levels.
Collapse
Affiliation(s)
- Andrea Acevedo
- Department of Community Health, Tufts University, Medford, Massachusetts
| | - Jennifer Miles
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Grant Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kevin Campbell
- Research and Data Analysis, Washington State Department of Social and Health Services, Olympia, Washington
| | - Deborah Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| |
Collapse
|