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Salehian S, Cunningham P, Barnes A, Lee SYD. The Cumulative Effect of Expanding the Breadth and Scope of Coverage for Substance Use Disorder Treatment on Behavioral Health Acute Inpatient Admissions: Evidence from Virginia Medicaid. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:777. [PMID: 38929023 PMCID: PMC11204056 DOI: 10.3390/ijerph21060777] [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: 05/16/2024] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
We evaluated the impact of Medicaid policies in Virginia (VA), namely the Addiction and Recovery Treatment Services (ARTS) program and Medicaid expansion, on the number of behavioral health acute inpatient admissions from 2016 to 2019. We used Poisson fixed-effect event study regression and compared average proportional differences in admissions over three time periods: (1) prior to ARTS; (2) following ARTS but before Medicaid expansion; (3) post-Medicaid expansion. The number of behavioral health acute inpatient admissions decreased by 2.6% (95% CI [-5.1, -0.2]) in the first quarter of 2018 and this decrease gradually intensified by 4.9% (95% CI [-7.5, -2.4]) in the fourth quarter of 2018 compared to the second quarter of 2017 (beginning of ARTS) in VA relative to North Carolina (NC). Following the first quarter of 2019 (beginning of Medicaid expansion), decreases in VA admissions became larger relative to NC. The average proportional difference in admissions estimated a decrease of 2.7% (95% CI, [-4.1, -0.8]) after ARTS but before Medicaid expansion and a decrease of 2.9% (95% CI, [-6.1, 0.4]) post-Medicaid expansion compared to pre-ARTS in VA compared to NC. Behavioral health acute inpatient admissions in VA decreased following ARTS implementation, and the decrease became larger after Medicaid expansion.
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Affiliation(s)
- Shiva Salehian
- Department of Health Policy, School of Population Health, Virginia Commonwealth University, Richmond, VA 23219, USA; (P.C.); (A.B.); (S.-Y.D.L.)
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Larsen AR, Cummings JR, von Esenwein SA, Druss BG. Trends in Alcohol Use Disorder Treatment Utilization and Setting From 2008 to 2017. Psychiatr Serv 2022; 73:991-998. [PMID: 35193376 DOI: 10.1176/appi.ps.202000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about recent trends in treatment for alcohol use disorder. The authors used national data to examine treatment trends among individuals with alcohol use disorder. METHODS A sample of nonelderly adults (ages 18-64 years, N=36,707) with alcohol use disorder was identified from the National Survey on Drug Use and Health. Multinomial logistic regression analysis was conducted to examine trends in treatment for alcohol use disorder in 2008-2010, 2011-2013, and 2014-2017 in any medical setting (hospitals, rehabilitation centers, mental health centers, emergency departments, and private doctors' offices), self-help groups only (no medical setting), and no setting (i.e., no treatment). Additional analyses investigated trends in mental health treatment. Regression models adjusted for predisposing, enabling, and need-related characteristics. RESULTS Among those with an alcohol use disorder, the percentage who received any treatment was significantly lower in 2011-2013 (5.6%) than in 2008-2010 (6.9%) (p<0.05). In adjusted analyses, the probability of receiving no treatment increased by 1.5 percentage points in 2014-2017 (95% CI=0.5-2.5) compared with the 2008-2010 baseline. Significant declines were observed in the receipt of any treatment in a medical setting (marginal effect [ME]=-1.0%, 95% CI=-2.0 to -0.0) and self-help treatment only (ME=-0.5%, 95% CI=-0.8 to -0.1) in 2014-2017 compared with the baseline period. The probability of receiving any mental health treatment did not change during the study period. CONCLUSIONS Among persons with an alcohol use disorder, treatment declined from 2008 to 2017. Future studies should examine the mechanisms that may be responsible for this decline.
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Affiliation(s)
- Aidan R Larsen
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Janet R Cummings
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Silke A von Esenwein
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Benjamin G Druss
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
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Khan AR, Olatunji O, Qureshi D, Metellus P, Nkemjika S. Accessibility of Treatment Among Women With Opioid Use Disorder: A Brief Review. Cureus 2022; 14:e27509. [PMID: 36060319 PMCID: PMC9426717 DOI: 10.7759/cureus.27509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 12/05/2022] Open
Abstract
Opioid-use disorder (OUD) has become a social pandemic with a rising incidence and prevalence among women. Notably, women with OUD were more likely to have psychiatric comorbidities like major depressive disorder, anxiety disorder, and bipolar disorder. Evidence suggests that opioid exposure and subsequent disease among women compared to men is unique and attributable to hormonal estrogen levels. However, there remains a dearth of literature on their ability to access treatment when needed. There is also a gap in the perceived access to women as compared to men. Hence, our review will focus on factors that may affect women from seeking OUD treatment as compared to men.
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Lewis R, Baugher AR, Finlayson T, Wejnert C, Sionean C. Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018. J Infect Dis 2021; 222:S420-S428. [PMID: 32877551 DOI: 10.1093/infdis/jiaa337] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Medicaid expansion under the Affordable Care Act increased insurance coverage, access to healthcare, and substance use disorder treatment, for many Americans. We assessed differences in healthcare access and utilization among persons who inject drugs (PWID) by state Medicaid expansion status. METHODS In 2018, PWID were interviewed in 22 US cities for National HIV Behavioral Surveillance. We analyzed data from PWID aged 18-64 years who reported illicit use of opioids (n = 9957) in the past 12 months. Poisson regression models with robust standard errors were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were used to examine differences by Medicaid expansion status in indicators of healthcare access and utilization. RESULTS Persons who inject drugs in Medicaid expansion states were more likely to have insurance (87% vs 36%; aPR, 2.3; 95% CI, 2.0-2.6), a usual source of healthcare (53% vs 34%; aPR, 1.5; 95% CI, 1.3-1.9), and have used medication-assisted treatment (61% vs 36%; aPR, 1.4; 95% CI, 1.1-1.7), and they were less likely to have an unmet need for care (21% vs 39%; aPR, 0.6; 95% CI, 0.4-0.7) than those in nonexpansion states. CONCLUSIONS Low insurance coverage, healthcare access, and medication-assisted treatment utilization among PWID in some areas could hinder efforts to end the intertwined human immunodeficiency virus and opioid overdose epidemics.
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Affiliation(s)
- Rashunda Lewis
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy R Baugher
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Teresa Finlayson
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cyprian Wejnert
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Catlainn Sionean
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Olfson M, Wall M, Barry CL, Mauro C, Feng T, Mojtabai R. Medicaid Expansion and Low-Income Adults with Substance Use Disorders. J Behav Health Serv Res 2020; 48:477-486. [PMID: 33156464 DOI: 10.1007/s11414-020-09738-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
Problems accessing affordable treatment are common among low-income adults with substance use disorders. A difference-in-differences analysis was performed to assess changes in insurance and treatment of low-income adults with common substance use disorders following the 2014 ACA Medicaid expansion, using data from the 2008-2017 National Surveys on Drug Use and Health. Lack of insurance among low-income adults with substance use disorders in expansion states declined from 34.8% (2012-2013) to 20.0% (2014-2015) to 13.5% (2016-2017) while Medicaid coverage increased from 24.8% (2012-2013) to 48.0% (2016-2017). In nonexpansion states, lack of insurance declined from 44.8% (2012-2013) to 34.2% (2016-2017) and Medicaid coverage increased from 14.3% (2012-2013) to 23.4% (2016-2017). Treatment rates remained low and little changed. Medicaid expansion contributed to insurance coverage gains for low-income adults with substance use disorders, although persistent treatment gaps underscore clinical and policy challenges of engaging these newly insured adults in treatment.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeon, Columbia University, and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA.
| | - Melanie Wall
- Department of Psychiatry, College of Physicians and Surgeon, Columbia University, and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Colleen L Barry
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Tianshu Feng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ramin Mojtabai
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Siniscalchi KA, Broome ME, Fish J, Ventimiglia J, Thompson J, Roy P, Pipes R, Trivedi M. Depression Screening and Measurement-Based Care in Primary Care. J Prim Care Community Health 2020; 11:2150132720931261. [PMID: 33185122 PMCID: PMC7673056 DOI: 10.1177/2150132720931261] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The health issue addressed is the unmet need to universally screen and treat depression, which is one of the most common mental health disorders among adults in the United States. The US Preventive Services Task Force recommends screening adults for depression in primary care and using evidence-based protocols. This quality improvement project implemented VitalSign6, a measurement-based care program, to improve depression screening and treatment of adults in primary care at an academic medical center. A pre-post design was used to determine effectiveness of changes in screening, outcomes, and satisfaction. Of 1200 unique adult patients, 95.4% received initial screening. Providers diagnosed and administered measurement-based care to 236 patients. After 14 weeks, 27.5% returned for at least 1 follow-up. Results showed a statistically significant decrease in self-reported depression scores from baseline to follow-up. VitalSign6 was effective in improving identification and management of depression in primary care.
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Affiliation(s)
| | | | - Jason Fish
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Ronny Pipes
- UT Southwestern Medical Center, Dallas, TX, USA
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