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Palzes VA, Chi FW, Weisner C, Kline-Simon AH, Satre DD, Sterling S. Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 38898220 DOI: 10.1111/acer.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Variation in specialty treatment utilization for alcohol use disorder (AUD) by patient subgroups is poorly understood. This study examined whether and how patient risk profiles predict receipt of specialty treatment and whether there are disparities by race and ethnicity. METHODS This cohort study included 206,956 adults with heavy alcohol use (that which exceeded National Institute on Alcohol Abuse and Alcoholism guidelines) between June 1, 2013 and December 31, 2014, using electronic health record data from Kaiser Permanente Northern California. Five risk profiles (characterized by daily or weekly heavy drinking and level of health risks) were identified in latent class analysis. Logistic regression models were fit to examine associations between risk profiles, race, ethnicity, and receipt of specialty treatment (including addiction medicine, psychiatry, or integrated behavioral health visits, and AUD pharmacotherapy), adjusting for other patient characteristics. Variation in the association between risk profiles and receipt of specialty treatment by race/ethnicity was also examined. RESULTS Overall, 4.0% of patients received specialty treatment. Latino/Hispanic and Asian/Pacific Islander patients had lower odds of receiving specialty treatment than White patients (adjusted odds ratio [aOR] [95% CI] = 0.80 [0.75, 0.85], and 0.64 [0.59, 0.70], respectively). The substance use disorder and mental health disorder (SUD/MH) risk profile had the highest odds of receiving specialty treatment (10.46 [9.65, 11.34]). Associations between risk profiles and receipt of specialty treatment significantly differed by race/ethnicity. Black patients in the SUD/MH risk profile, and Hispanic/Latino patients in the risk profile with heavy daily drinking and more health risks, had lower odds of receiving specialty treatment than their White counterparts (adjusted ratio of odds ratios [aROR] [95% CI] = 0.69 [0.50, 0.94], and 0.79 [0.67, 0.92], respectively). CONCLUSIONS This study provides new insights into racial/ethnic disparities in specialty treatment utilization for alcohol problems. Findings may help inform strategies for tailoring interventions to address heavy alcohol use.
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Affiliation(s)
- Vanessa A Palzes
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
| | - Felicia W Chi
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
| | - Constance Weisner
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
| | - Derek D Satre
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Stacy Sterling
- Division of Research, Center for Addiction and Mental Health Research, Kaiser Permanente, Pleasanton, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Bachrach RL, Frost MC, Fletcher OV, Chen JA, Chinman M, Ellis R, Williams EC. Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status. J Addict Med 2024:01271255-990000000-00331. [PMID: 38842176 DOI: 10.1097/adm.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Medications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections. METHODS Among all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences. RESULTS The overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall. CONCLUSIONS Substantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.
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Affiliation(s)
- Rachel L Bachrach
- From the Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (RLB); Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI (RLB); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA (MCF, OVF, JAC, ECW); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (MCF, RE, ECW); The RAND Corporation, Pittsburgh, PA (MC); Center for Health Equity Research and Promotion; Mental Illness Research, Education, and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, PA (MC); Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (MC); and Kaiser Permanente Washington Health Research Institute, Seattle, WA (RE)
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3
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Perumalswami PV, Adams MA, Frost MC, Holleman R, Kim HM, Zhang L, Lin LA. Telehealth and delivery of alcohol use disorder treatment in the Veterans Health Administration. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:944-954. [PMID: 38529689 DOI: 10.1111/acer.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The use of telehealth treatment of alcohol use disorder (AUD) has increased since the start of the COVID-19 pandemic. However, it is unclear which patients are using telehealth and how telehealth visits are associated with treatment duration. This study examined characteristics associated with telehealth use among Veterans Health Administration patients receiving AUD treatment. METHODS Using a national retrospective cohort study, we examined data from March 01, 2020 to February 28, 2021 to: First, identify patient characteristics associated with (a) any telehealth versus only in-person care for AUD treatment, and (b) video (≥1 video visit) versus only telephone visits for AUD treatment (≥1 telephone visit, no video) among any telehealth users. This analysis used mixed-effects logistic regression models to adjust for potential correlation across patients treated at the same facility. Second, we assessed whether visit modality was associated with the amount of AUD treatment received (number of AUD psychotherapy visits or medication coverage days). This analysis used mixed-effects negative binomial regression models. RESULTS Among 138,619 patients who received AUD treatment, 52.8% had ≥1 video visit, 38.1% had ≥1 telephone but no video visits, and 9.1% had only in-person visits. In the regression analyses, patients who were male or had an opioid or stimulant use disorder (compared to having no non-AUD substance use disorder) were less likely to receive any telehealth-delivered AUD treatment compared to only in-person AUD treatment. Among patients who received any telehealth-delivered AUD treatment, those who were ≥45 years old (compared to 18-29 years old), Black (compared to White), diagnosed with a cannabis or stimulant use disorder, or diagnosed with a serious mental illness were less likely to receive a video visit than only telephone visits. Receiving any AUD telehealth was associated with receiving more psychotherapy visits and medication coverage days than only in-person care. CONCLUSIONS Telehealth, a common modality for AUD treatment, supported a greater number of psychotherapy visits and a longer duration of medication treatment for AUD. However, some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access.
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Affiliation(s)
- Ponni V Perumalswami
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Megan A Adams
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Madeline C Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rob Holleman
- Health Services Research & Development, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Hyungjin Myra Kim
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, Michigan, USA
| | - Lan Zhang
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lewei Allison Lin
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, Michigan, USA
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Mintz CM, Knox J, Hartz SM, Hasin DS, Martins SS, Kranzler HR, Greene E, Geng EH, Grucza RA, Bierut LJ. Demographic differences in the cascade of care for unhealthy alcohol use: A cross-sectional analysis of data from the 2015-2019 National Survey on Drug Use and Health. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1890-1903. [PMID: 37864538 PMCID: PMC10590988 DOI: 10.1111/acer.15176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 08/15/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The screening, brief intervention, and referral to treatment (SBIRT) model is recommended by the U.S. Preventive Services Task Force to improve recognition of and intervention for unhealthy alcohol use. How SBIRT implementation differs by demographic characteristics is poorly understood. METHODS We analyzed data from the 2015-2019 National Survey on Drug Use and Health from respondents ≥18 years old who used an outpatient clinic and had at least one alcoholic drink within the past year. Respondents were grouped into one of three mutually exclusive groups: "no binge drinking or alcohol use disorder (AUD)," "binge drinking without AUD," or "AUD." Outcome variables were likelihood of screening, brief intervention (BI), referral to treatment (RT), and AUD treatment. The demographic predictors on which outcomes were regressed included gender, age, race and ethnicity, sexual orientation, insurance status, and history of military involvement. Consistent with SBIRT guidelines, the entire sample was included in the screening model; screened persons with either binge drinking without AUD or with AUD were included in the BI model; screened persons with AUD were included in the RT model, and persons referred to treatment with AUD were included in the AUD treatment model. RESULTS Analyses included 120,804 respondents. Women were more likely than men to be screened, but less likely to receive BI or RT. When referred to treatment, women were more likely than men to receive it. Persons aged ≥50 were least likely to be screened about alcohol, but most likely to receive BI, while persons aged 18-25 were least likely to receive BI or AUD treatment. Racial and ethnic minorities were less likely than White persons to be screened; Asians were less likely to receive RT, and Black persons were less likely to receive treatment than White persons. Persons identifying as gay, lesbian, or bisexual were equally as likely or more likely to receive SBIRT or AUD treatment as those identifying as heterosexual. Persons without insurance were less likely to be screened than those with insurance. Persons with a history of military involvement were more likely to be screened and receive BI and RT than persons who had not served in the military. CONCLUSIONS Demographic disparities in SBIRT implementation exist. Addressing the sources of these disparities and minimizing attrition from care could improve outcomes for persons with unhealthy alcohol use.
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Affiliation(s)
- Carrie M. Mintz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Emily Greene
- Physician Assistant Program, The City College of New York School of Medicine, New York, New York, USA
| | - Elvin H. Geng
- Department of Medicine, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
| | - Richard A. Grucza
- Department of Family Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
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Phillips AZ, Karriker-Jaffe KJ, Bensley KMK, Subbaraman MS, Delk J, Mulia N. Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough? Alcohol Clin Exp Res 2023; 47:1390-1405. [PMID: 37421544 PMCID: PMC10524486 DOI: 10.1111/acer.15102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND We investigate whether living in a state that expanded Medicaid eligibility is associated with receiving alcohol screening and brief counseling among nonelderly, low-income adults and a subgroup with chronic health conditions caused or exacerbated by alcohol use. METHOD Data are from the 2017 and 2019 Behavioral Risk Factor Surveillance System (N = 15,743 low-income adults; n = 7062 with a chronic condition). We used propensity score-weighted, covariate-adjusted, modified Poisson regression to estimate associations between residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling. Models estimated associations in the overall sample and chronic conditions subsample, as well as differential associations across sex, race, and ethnicity using interaction terms. RESULTS Living in a state that expanded Medicaid eligibility was associated with being asked whether one drank (prevalence ratio (PR) = 1.15, 95% confidence interval (CI) = 1.08, 1.22), but not with further alcohol screening, guidance about harmful drinking, or advice to reduce drinking. Among individuals with alcohol-related chronic conditions, expansion state residence was associated with being asked about drinking (PR = 1.13, 95% CI = 1.05, 1.20) and, among past 30-day drinkers with chronic conditions, being asked how much one drank (PR = 1.28, 95% CI = 1.04, 1.59) and about binge drinking (PR = 1.43, 95% CI = 1.03, 1.99). Interaction terms suggest that some associations differ by race and ethnicity. CONCLUSIONS Living in a state that expanded Medicaid is associated with a higher prevalence of receiving some alcohol screening at a check-up in the past 2 years among low-income residents, particularly among individuals with alcohol-related chronic conditions, but not with the receipt of high-quality screening and brief counseling. Policies may have to address provider barriers to delivery of these services in addition to access to care.
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Affiliation(s)
- Aryn Z. Phillips
- Northwestern University, Feinberg School of Medicine, Department of Preventive Medicine, 680 N. Lakeshore Drive Suite 1400, Chicago, IL 60611, USA
- University of Maryland School of Public Health, Department of Health Policy and Management, 4200 Valley Drive, College Park, MD 20742, USA
| | | | - Kara M. K. Bensley
- Bastyr University, Department of Public Health, 1400 Juanita Drive NE, Kenmore, WA 98028
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
| | - Meenakshi S. Subbaraman
- Public Health Institute, Behavioral Health and Recovery Studies, 555 12 Street Suite 600, Oakland, CA 94607, USA
| | - Joanne Delk
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
| | - Nina Mulia
- Alcohol Research Group, 6001 Shellmound Street Suite 450, Emeryville, CA 94608, USA
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Cano MT, Reavis JV, Pennington DL. Perceived discrimination enhances the association between distress and impact related to the murder of George Floyd and unhealthy alcohol use in a survey sample of U.S. Veterans who report drinking. Addict Behav Rep 2023; 17:100481. [PMID: 36713472 PMCID: PMC9876779 DOI: 10.1016/j.abrep.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/16/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction On May 25, 2020, George Floyd was murdered by a Minneapolis police officer leading to increased social justice and antiracism movements (SJARM) across the United States. Vicarious exposure to racism and perceived discrimination are salient sources of distress which may lead to increased alcohol use as means of coping. The primary aim of the current study was to examine how perceived discrimination and the subjective impact and personal distress related to the SJARM following the George Floyd murder interact and relate to unhealthy alcohol use among U.S. Veterans. Methods 286 Veterans were assessed for unhealthy alcohol use (AUDIT-10), perceived discrimination (EDS), and subjective impact and personal distress related to the SJARM. Two moderation analyses were performed to examine whether subjective impact and personal distress moderated relations between perceived discrimination and alcohol use. In-depth follow-up analyses were conducted to examine differences and relationships among variables. Results In two different moderation models, perceived discrimination moderated the association between both subjective impact (p <.001) and personal distress (p <.001) felt by the SJARM and unhealthy alcohol use. In planned exploratory analyses, Veterans who reported perceived discrimination reported higher levels of unhealthy alcohol use (M = 14.71, SD = 9.39) than those who did not t(2 8 4) = 5.61, p <.001. In post-hoc analyses, racial/ethnic minorities were significantly more likely to report perceived racial discrimination (p <.001) while non-Hispanic Whites were more likely to report perceived discrimination based on education or income level (p <.01). Conclusions In the context of a socially unjust event amidst a global pandemic, perceived discrimination contributes to unhealthy alcohol use and subjective impact and personal distress associated with the SJARM following the murder of George Floyd. Results highlight the importance of addressing discrimination experiences in Veterans who seek alcohol treatment, particularly as rates of unhealthy alcohol use are on the rise.
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Affiliation(s)
- Monique T. Cano
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
| | - Jill V. Reavis
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
- Palo Alto University, Palo Alto, CA 94304, United States
| | - David L. Pennington
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, United States
- San Francisco VA Health Care System, San Francisco, CA 94121, United States
- Northern California Institute for Research and Education (NCIRE), San Francisco, CA 94121, United States
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Vickers-Smith R, Justice AC, Becker WC, Rentsch CT, Curtis B, Fernander A, Hartwell EE, Ighodaro ET, Kember RL, Tate J, Kranzler HR. Racial and Ethnic Bias in the Diagnosis of Alcohol Use Disorder in Veterans. Am J Psychiatry 2023; 180:426-436. [PMID: 37132202 PMCID: PMC10238581 DOI: 10.1176/appi.ajp.21111097] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Studies show that racially and ethnically minoritized veterans have a higher prevalence of alcohol use disorder (AUD) than White veterans. The investigators examined whether the relationship between self-reported race and ethnicity and AUD diagnosis remains after adjusting for alcohol consumption, and if so, whether it varies by self-reported alcohol consumption. METHODS The sample included 700,012 Black, White, and Hispanic veterans enrolled in the Million Veteran Program. Alcohol consumption was defined as an individual's maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. A diagnosis of AUD, the primary outcome, was defined by the presence of relevant ICD-9 or ICD-10 codes in electronic health records. Logistic regression with interactions was used to assess the association between race and ethnicity and AUD as a function of maximum AUDIT-C score. RESULTS Black and Hispanic veterans were more likely than White veterans to have an AUD diagnosis despite similar levels of alcohol consumption. The difference was greatest between Black and White men; at all but the lowest and highest levels of alcohol consumption, Black men had 23%-109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol consumption, alcohol-related disorders, and other potential confounders. CONCLUSIONS The large discrepancy in the prevalence of AUD across groups despite a similar distribution of alcohol consumption levels suggests that there is racial and ethnic bias, with Black and Hispanic veterans more likely than White veterans to receive an AUD diagnosis. Efforts are needed to reduce bias in the diagnostic process to address racialized differences in AUD diagnosis.
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Affiliation(s)
- Rachel Vickers-Smith
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- Department of Epidemiology and Environmental Health, University of Kentucky College of Public Health, Lexington, KY 40536
| | - Amy C. Justice
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - William C. Becker
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - Christopher T. Rentsch
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK WC1E 7HT
| | - Brenda Curtis
- National Institute on Drug Abuse Intramural Research Program, Baltimore, MD 21224
| | - Anita Fernander
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL 33431
| | - Emily E. Hartwell
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | | | - Rachel L. Kember
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Janet Tate
- Yale School of Medicine, New Haven, CT 06511
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - Henry R. Kranzler
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Philadelphia, PA 19104
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
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Wang CL, Kanamori M, Moreland-Capuia A, Greenfield SF, Sugarman DE. Substance use disorders and treatment in Asian American and Pacific Islander women: A scoping review. Am J Addict 2023; 32:231-243. [PMID: 36573305 PMCID: PMC10121752 DOI: 10.1111/ajad.13372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/15/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Asian American Pacific Islanders (AAPIs) face unique barriers in seeking treatment for substance use disorders (SUD) and are less likely than the general population to receive treatment. Barriers specific to AAPI women may be especially significant given identified gender and racial differences in SUD prevalence and treatment. This review examines rates of SUD in AAPI women and summarizes the literature on SUD treatment for AAPI women. METHODS Data from 2016 to 2019 National Survey on Drug Use and Health (NSDUH) surveys were extracted to summarize rates of SUD. A scoping review of the literature on AAPI women and SUD treatment was conducted; eight articles published from 2010 to present were reviewed. RESULTS The prevalence of SUDs among AAPI women increased overall, although rates of SUDs were generally lower in AAPI women compared to their male counterparts. Patterns of gender differences in SUDs varied for subpopulations of AAPI women. There is limited research on treatment utilization and access for AAPI women. The few studies that examined treatment outcomes found favorable outcomes for AAPI women; research on culturally adapted interventions was promising but nascent. DISCUSSION AND CONCLUSIONS Literature on SUD treatment for AAPI women is limited. The availability of more culturally tailored treatments addressing the specific needs of AAPI women may lead to more acceptability and treatment utilization for this group. Additional research is needed to elucidate the unique barriers to treatment AAPI women face. SCIENTIFIC SIGNIFICANCE With rising rates of substance use in AAPI women, there is a need to develop and test effective SUD treatments adapted for AAPI women.
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Affiliation(s)
| | | | - Alisha Moreland-Capuia
- McLean Hospital, Belmont MA 02478
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115
| | - Shelly F. Greenfield
- McLean Hospital, Belmont MA 02478
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115
| | - Dawn E. Sugarman
- McLean Hospital, Belmont MA 02478
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Weisner CM, Satre DD, Grant RW, Elson J, Ross TB, Awsare S, Lu Y, Metz VE, Sterling SA. Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study. BMJ Open 2023; 13:e064088. [PMID: 36657762 PMCID: PMC9853251 DOI: 10.1136/bmjopen-2022-064088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D). DESIGN A population-based observational study using electronic health records data. SETTING An integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care. PARTICIPANTS Adult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017. MAIN OUTCOME MEASURES We examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and 'controlled HbA1c' (HbA1c<8%) at 18-month follow-up. RESULTS For patients with hypertension, those who received BI had a modest but significant additional -0.06 reduction in drinks/drinking day (95% CI -0.11 to -0.01) and additional -0.30 reduction in drinks/week (95% CI -0.59 to -0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined. CONCLUSIONS Alcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI's long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Joseph Elson
- Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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10
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Bachrach RL, Quinn DA. The role of gender and veteran status in healthcare access among a national sample of U.S. adults with unhealthy alcohol use. Subst Use Misuse 2023; 58:491-499. [PMID: 36722613 DOI: 10.1080/10826084.2023.2170182] [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: 02/02/2023]
Abstract
Background: Routine healthcare access is critical to reduce drinking and its effects, yet little is known about Veteran and gender differences in routine healthcare access among unhealthy drinkers. The current study examined differences in routine healthcare access, stratified by Veteran status and gender, among a national sample of adults endorsing unhealthy drinking. Method: Using data from the Centers for Disease Control and Prevention's 2019 Behavioral Risk Factor Surveillance System National Survey, we identified adults who endorsed unhealthy drinking over the past month (N = 58,816; 41.4% female; 2.7% female Veterans). Bivariate and multivariable analyses modeled associations between gender, Veteran status, and their interaction in predicting routine healthcare access. All multivariable models adjusted for sociodemographic characteristics. Results: Veterans with unhealthy alcohol use reported high rates of routine healthcare access (e.g., >86% sought care in the past 2 years) and were less likely to experience a cost barrier to care (aOR = 0.75, 95% CI = 0.62-0.92). Females were more likely than males to report better access to care but also to experience a cost barrier (aOR = 1.2, 95% CI = 1.10-1.37). The interaction between Veteran status and gender was non-significant. Conclusions: Overall, healthcare access was better for Veterans and females with unhealthy alcohol use compared to civilians and males with unhealthy alcohol use. However, given that females were more likely to report a cost barrier, future implementation research aiming to improve equity in care may want to explore reasons for cost barriers and develop strategies to help reduce these barriers in order to eliminate gender disparities in primary care-based alcohol-related care.
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Affiliation(s)
- Rachel L Bachrach
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deirdre A Quinn
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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11
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Matson TE, Harris AHS, Chen JA, Edmonds AT, Frost MC, Rubinsky AD, Blosnich JR, Williams EC. Influence of a national transgender health care directive on receipt of alcohol-related care among transgender Veteran Health Administration patients with unhealthy alcohol use. J Subst Abuse Treat 2022; 143:108808. [PMID: 35715286 DOI: 10.1016/j.jsat.2022.108808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 04/16/2022] [Accepted: 05/20/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Transgender persons are vulnerable to under-receipt of recommended health care due to chronic exposure to systemic stressors (e.g., discriminatory laws and health system practices). Scant information exists on receipt of alcohol-related care for transgender populations, and whether structural interventions to reduce transgender discrimination in health care improve receipt of recommended treatment. This study evaluated the effect of the Veteran Health Administration (VA) Transgender Healthcare Directive-a national policy to reduce structural discrimination-on receipt of evidence-based alcohol-related care for transgender VA patients with unhealthy alcohol use. METHODS The study used an interrupted time series with control design to compare monthly receipt of alcohol-related care among transgender patients with unhealthy alcohol use (Alcohol Use Disorders Identification Test Consumption ≥5) documented in their electronic health record before (10/1/2009-5/31/2011) and after (7/1/2011-7/31/2017) implementation of VA's Transgender Healthcare Directive. A propensity-score matched sample of non-transgender patients with unhealthy alcohol use served as a comparison group to control for concurrent secular trends. Mixed effects segmented logistic regression models estimated changes in level and slope (i.e., rate of change) in receipt of any evidence-based alcohol-related care, including brief intervention, specialty addictions treatment, and alcohol use disorder medications. RESULTS The matched sample (mean age = 47.5 [SD = 15.0]; 75% non-Hispanic White race/ethnicity) included 2074 positive alcohol screens completed by 1377 transgender patients and 6,l99 positive alcohol screens completed by 6185 non-transgender patients. Receipt of alcohol-related care increased for transgender patients from 78.5% (95% CI: 71.3%-85.6%) at the start of study to 83.0% (75.9%-90.1%) immediately before the directive and decreased slightly from 81.6% (77.4%-85.9%) immediately after the directive to 80.1% (76.8-85.4) at the end of the study. Changes in level and slope comparing periods before and after the directive were not statistically significant, nor were they statistically significantly different from the matched sample of non-transgender patients. CONCLUSIONS Health systems must urgently employ and evaluate policies to address structural stigma that produces and reproduces disparities in health and health care. Although VA's directive was not associated with increased receipt of alcohol-related care, that receipt of alcohol-related care among transgender patients is comparable to non-transgender patients is promising.
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Affiliation(s)
- Theresa E Matson
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation, Veterans Affairs (VA) Palo Alto Healthcare System, Menlo Park, CA 94304, USA; Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Jessica A Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA.
| | - Amy T Edmonds
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Madeline C Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA.
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34(th) St., Los Angeles, CA 90089, USA; Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA 15219, USA.
| | - Emily C Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
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12
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Salem K, Randles R, Sapre B, Finnegan A. Experiences of ethnic minority personnel in the armed forces: A systematic review. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2022. [DOI: 10.3138/jmvfh-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
LAY SUMMARY An armed forces consisting of personnel from diverse and ethnic minority backgrounds offers considerable benefits, not just in terms of reflecting society but for improving the effectiveness of military operations. Many ethnic minority individuals serve for long periods, during which they experience personal growth and benefit from military service. However, little research has explored the impact these experiences might have on ethnic minority communities within the Armed Forces, who report higher levels of being bullying, harassment, and discrimination. Given the lack of empirical research into armed forces ethnic minority personnel, this systematic review aimed to provide insight into and understanding of existing international research, relevant reports, and policy. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and included articles written in English since 2010. The review identified three themes — cultural identity, health status and health utilization, and trauma and discrimination — and indicated that ethnic minority personnel experience greater disadvantage than their native counterparts, both during and after service.
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Affiliation(s)
- Kate Salem
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Rebecca Randles
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
| | - Bhairavi Sapre
- Perinatal Mental Health Service, Cheshire and Wirral NHS Foundation Trust, Cheshire, United Kingdom
| | - Alan Finnegan
- Westminster Centre for Research in Veterans, University of Chester, Chester, United Kingdom
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13
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Strewler A, Bellamy K. Caring for Veteran Women. Nurs Clin North Am 2022; 57:359-373. [DOI: 10.1016/j.cnur.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Williams EC, Fletcher OV, Frost MC, Harris AHS, Washington DL, Hoggatt KJ. Comparison of Substance Use Disorder Diagnosis Rates From Electronic Health Record Data With Substance Use Disorder Prevalence Rates Reported in Surveys Across Sociodemographic Groups in the Veterans Health Administration. JAMA Netw Open 2022; 5:e2219651. [PMID: 35771574 PMCID: PMC9247731 DOI: 10.1001/jamanetworkopen.2022.19651] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Substance use disorders (SUDs) are major contributors to morbidity and mortality globally, but they are often underrecognized and underdiagnosed, particularly in some sociodemographic subgroups. Understanding the extent to which clinical diagnoses underestimate these conditions within subgroups is imperative to achieving equitable treatment, regardless of race, ethnicity, gender, or age, and to informing and improving performance monitoring. Objective To compare clinically documented diagnosis rates of alcohol use disorder (AUD), drug use disorder (DUD), and total SUD (AUD and/or DUD) with the prevalence of these disorders as reported in surveys-based on structured, validated diagnostic assessments-across demographic subgroups. Design, Setting, and Participants A telephone-based survey was conducted from January 8, 2018, to April 30, 2019, among 5995 Veterans Health Administration (VHA) outpatients who were randomly sampled from 30 VHA facilities and were 18 years of age or older, could complete the survey in English, and had a valid address and telephone number. Survey data were linked to electronic health record (EHR) data for all participants. Statistical analysis was performed between January 29, 2020, and April 20, 2021. Exposures Demographic subgroups based on self-report: gender (male or female), age (18-34, 35-49, 50-64, 65-74, and ≥75 years), and race and ethnicity (Black non-Hispanic, Hispanic, multiracial, other [Asian or Asian-American, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, and any other race endorsed by the participant], and White non-Hispanic). Main Outcomes and Measures Survey-based prevalence rates of AUD, DUD, and SUD were assessed using the Mini International Neuropsychiatric Interview, version 7.0, the only validated instrument available at study outset that measured Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for past 12-month diagnoses. Clinically documented diagnosis rates were measured using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses from VHA EHR data. Analyses compared survey-based prevalence rates of AUD, DUD, and SUD with diagnosis rates using sensitivity and specificity and difference-in-difference analysis. All analyses were weighted with survey weights to account for nonresponse. Results Of 5995 participants, 4115 (68.6%) were White non-Hispanic, and 5429 (91.1%) were male; the mean (SD) age was 61.5 (15.3) years. The survey-based prevalence rates of AUD, DUD, and SUD were higher than the diagnosis rates among all patients (AUD, 608 [10.1%] vs 360 [6.0%]; DUD, 282 [4.7%] vs 275 [4.6%]; SUD, 768 [12.8%] vs 515 [8.6%]). Survey-based prevalence rates of AUD and SUD exceeded the diagnosis rates in every demographic subgroup. Gaps between diagnosis rates and survey-based prevalence rates for AUD and SUD were largest among patients aged 18 to 34 years (AUD diagnosis rate, 27 [6.9%; 95% CI, 4.8%-9.9%] vs AUD prevalence rate, 88 [22.4%; 95% CI, 17.3%-28.5%]; SUD diagnosis rate, 41 [10.5%; 95% CI, 8.1%-13.4%] vs SUD prevalence rate, 109 [27.7%; 95% CI, 22.6%-33.3%]) and Hispanic and Latinx patients (AUD diagnosis rate, 31 [7.6%; 95% CI, 5.3%-10.8%] vs AUD prevalence rate, 72 [17.7%; 95% CI, 14.0%-22.1%]; and SUD diagnosis rate, 48 [11.7%; 95% CI, 7.9%-16.9%] vs SUD prevalence rate, 88 [21.6%; 95% CI, 18.0%-25.8%]). For DUD, only patients aged 18 to 34 years had a true prevalence rate that significantly exceeded the diagnosis rate (diagnosis rate, 21 [5.4%; 95% CI, 3.7%-7.8%] vs prevalence rate, 40 [10.1%; 95% CI, 7.2%-14.0%]). Conclusions and Relevance The results of this survey study suggest that existing diagnostic procedures and tools are insufficient to capture SUD prevalence rates, particularly among younger patients and Hispanic and Latinx patients. Clinics and health systems should implement standardized SUD assessments to ensure the provision of equitable care and the optimal identification of underlying conditions for performance monitoring.
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Affiliation(s)
- Emily C. Williams
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Olivia V. Fletcher
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Madeline C. Frost
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Alex H. S. Harris
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Donna L. Washington
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Katherine J. Hoggatt
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco
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15
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Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Lu Y, Sterling SA. Alcohol brief intervention, specialty treatment and drinking outcomes at 12 months: Results from a systematic alcohol screening and brief intervention initiative in adult primary care. Drug Alcohol Depend 2022; 235:109458. [PMID: 35453082 PMCID: PMC10122418 DOI: 10.1016/j.drugalcdep.2022.109458] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alcohol screening, brief intervention and referral to treatment (SBIRT) in adult primary care is an evidence-based, public health strategy to address unhealthy alcohol use, but evidence of effectiveness of alcohol brief intervention (ABI) in real-world implementation is lacking. METHODS We fit marginal structural models with inverse probability weighting to estimate the causal effects of ABI on 12-month drinking outcomes using longitudinal electronic health records data for 312,056 adults with a positive screening result for unhealthy drinking between 2014 and 2017 in a large healthcare system that implemented systematic primary care-based SBIRT. We examined effects of ABI with and without adjusting for receipt of specialty alcohol use disorder (AUD) treatment, and whether effects varied by patient demographic characteristics and alcohol use patterns. RESULTS Receiving ABI resulted in significantly greater reductions in heavy drinking days (mean difference [95% CI] = -0.26 [-0.45, -0.08]), drinking days per week (-0.04 [-0.07, -0.01]), drinks per drinking day (-0.05 [-0.08, -0.02]) and drinks per week (-0.16 [-0.27, -0.04]). Effects of ABI on 12-month drinking outcomes varied by baseline consumption level, age group and whether patients already had an AUD, with better improvement in those who were drinking at levels exceeding only daily limits, younger, and without an AUD. CONCLUSIONS Systematic ABI in adult primary care has the potential to reduce drinking among people with unhealthy drinking considerably on both an individual and population level. More research is needed to help optimize ABI, in particular tailoring it to diverse sub-populations, and studying its long-term public health impact.
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Affiliation(s)
- Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA; Department of Psychiatry, Weill Institute of Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Joseph Elson
- The Permanente Medical Group, 1600 Owens Street, San Francisco, CA 94158, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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16
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Miller MB, Flores LY, Dorimé-Williams ML, Williams MS, Martinez LD, Freeman LK, Everson AT, Hall NA, Monk JK, McCrae CS, Borsari B. Motives for and Barriers to Research Participation Among Racially and Ethnically Diverse Veterans. Mil Med 2022; 188:usac127. [PMID: 35584195 PMCID: PMC10363000 DOI: 10.1093/milmed/usac127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Veterans in general-and especially those who identify as Veterans of color-are underrepresented in health-related treatment research. This contributes to health inequity by hindering the development of evidence-based treatment recommendations for people of color. This project utilized culturally centered research procedures to identify health-related research priorities and examine motives for and barriers to research participation in a diverse sample of Veterans. MATERIALS AND METHODS Veterans (N = 330, 32% female; 36% Black, 28% White, 15% Latinx, 12% Asian, 4% Multiracial) reported their experiences with and perspectives on health-related research online from remote locations. Linear regression was used to test associations between discrimination and motives/barriers for research. All procedures were approved by the Institutional Review Board (#2033562). RESULTS Participants identified psychological concerns, particularly PTSD, as research priorities for Veterans in their communities, but also prioritized physical problems (e.g., brain injury) and social concerns (e.g., homelessness, access to care). Perceptions of, motives for, and barriers to research were similar across racial/ethnic groups. The most common motive was contributing to research that seems important, and the most common barrier was not knowing about research opportunities. Every-day experiences with discrimination (e.g., people acting as if they are afraid of you because of your race/ethnicity) were associated with more barriers to research among Black participants. CONCLUSIONS Experiences of racial/ethnic discrimination are associated with different research-related outcomes across racial/ethnic groups. Efforts to engage diverse populations should prioritize access to (not willingness to participate in) health-related research.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Lisa Y Flores
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | | | - Michael S Williams
- Department of Educational Leadership & Policy Analysis, University of Missouri, Columbia, MO 65211, USA
| | - Leticia D Martinez
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - Lindsey K Freeman
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Adam T Everson
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - Nicole A Hall
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
| | - J Kale Monk
- Human Development and Family Science, University of Missouri, Columbia, MO 65211, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, MO 65212, USA
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA 94143, USA
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Phillips KT, Pedula KL, Choi NG, Tawara KAK, Simiola V, Satre DD, Owen-Smith A, Lynch FF, Dickerson J. Chronic health conditions, acute health events, and healthcare utilization among adults over age 50 in Hawai'i who use cannabis: A matched cohort study. Drug Alcohol Depend 2022; 234:109387. [PMID: 35279458 DOI: 10.1016/j.drugalcdep.2022.109387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Research on cannabis-related health outcomes in diverse older adults is limited. The current study utilized a matched cohort study design to compare older adults in Hawai'i with identified cannabis diagnoses and matched controls on chronic health conditions, acute health events, and healthcare utilization from 2016 to 2020. METHOD Patients age 50 + were identified using ICD-10 diagnostic codes for cannabis use, abuse, and dependence using electronic health record data from an integrated health system (Kaiser Permanente Hawai'i). Those with cannabis diagnoses (n = 275) were compared to matched non-using controls (n = 275; based on age, sex) on chronic health conditions (coronary heart disease, hypertension, COPD, chronic non-cancer pain), acute health events (myocardial infarction, respiratory symptoms, stroke, persistent or cyclic vomiting, injuries), and healthcare utilization (outpatient, inpatient, and emergency department visits) following case identification for two years. RESULTS Participants were 19.3% Native Hawaiian/Pacific Islander, 24.4% Asian, 47.8% White, and 8.5% Other/Unknown, with an average age of 62.8 years (SD=7.3). Adjusting for covariates as possible, participants with a cannabis diagnosis had significantly greater risk of coronary heart disease, chronic non-cancer pain, stroke, myocardial infarction, cyclic vomiting, and injuries, over time, compared to controls. Cannabis use was associated with any and greater frequency of outpatient, inpatient, and emergency department visits. CONCLUSIONS In a diverse sample, older adults who used cannabis had worse health conditions and events and used more health services over a two-year period. Future studies should evaluate cannabis-related health outcomes, effects of cannabis problem severity, as well as implications for healthcare in aging populations.
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Affiliation(s)
- Kristina T Phillips
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA.
| | - Kathryn L Pedula
- Hawai'i Permanente Medical Group, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Kylee-Ann K Tawara
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Vanessa Simiola
- Center for Integrated Health Care Research, Kaiser Permanente Hawai'i, Honolulu, HI, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, USA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Ashli Owen-Smith
- School of Public Health, Georgia State University, Atlanta, GA, USA; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Frances F Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; OCHIN Research, Portland, OR, USA
| | - John Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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18
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Sterling SA, Chi FW, Palzes VA, Bryant KJ, Weisner CM, Silverberg MJ, Satre DD. Treatment for alcohol use disorder among persons with and without HIV in a clinical care setting in the United States. Drug Alcohol Depend 2021; 229:109110. [PMID: 34700145 PMCID: PMC8671330 DOI: 10.1016/j.drugalcdep.2021.109110] [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] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and persons without HIV (PWoH) with AUD. METHODS Using Poisson regression with GEE, we estimated prevalence ratios (PRs) comparing the annual probability of receiving AUD treatment (behavioral intervention or dispensed medication), adjusted for sociodemographics, psychiatric comorbidities, insurance type, and calendar year. Among PWH, we examined independent AUD treatment predictors using PRs adjusted for calendar year only. RESULTS PWH with AUD (N = 633; 93% men, median age 49) were likelier than PWoH with AUD (N = 7006; 95% men, median age 52) to have depression (38% vs. 21%) and a non-alcohol substance use disorder (SUD, 48% vs. 25%) (both P < 0.01). Annual probabilities of receiving AUD treatment were 45.4% for PWH and 34.4% for PWoH. After adjusting, there was no difference by HIV status (PR 1.02 [95% CI 0.94-1.11]; P = 0.61). Of treated PWH, 59% received only a behavioral intervention, 5% only a medication, and 36% both, vs. 67%, 4%, 30% for treated PWoH, respectively. Irrespective of HIV status, the most common medication was gabapentin. Among PWH, receiving AUD treatment was associated with having depression (PR 1.78 [1.51-2.10]; P < 0.01) and another SUD (PR 2.68 [2.20-3.27]; P < 0.01). CONCLUSIONS PWH with AUD had higher AUD treatment rates than PWoH with AUD in unadjusted but not adjusted analyses, which may be explained by higher psychiatric comorbidity burden among PWH.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Ave, San Francisco, CA 94143, USA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Vanessa A. Palzes
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA
| | - Constance M. Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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19
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Lu Y, Chi FW, Parthasarathy S, Palzes VA, Kline-Simon AH, Metz VE, Weisner C, Satre DD, Campbell CI, Elson J, Ross TB, Awsare SV, Sterling SA. Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care. Alcohol Clin Exp Res 2021; 45:2179-2189. [PMID: 34486124 DOI: 10.1111/acer.14702] [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] [Received: 03/30/2021] [Revised: 08/06/2021] [Accepted: 08/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors. METHODS This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017. RESULTS We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions. CONCLUSIONS These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.
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Affiliation(s)
- Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Andrea H Kline-Simon
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Verena E Metz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Joseph Elson
- The Permanente Medical Group, San Francisco, California, USA
| | - Thekla B Ross
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sameer V Awsare
- The Permanente Medical Group, TPMG Executive Offices, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute of Neurosciences, University of California, San Francisco, San Francisco, California, USA
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20
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Albright DL, McDaniel J, Suntai Z, Wallace J. Alcohol misuse among older military veterans: an intersectionality theory perspective. J Addict Dis 2021; 39:504-512. [PMID: 33709881 DOI: 10.1080/10550887.2021.1897201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alcohol misuse among older adults is an emerging public health issue. Older veterans are particularly at risk of developing substance use dependency due to the enduring impacts of military service. The purpose of this study was to test the theory of intersectionality on alcohol misuse by veteran status and age, veteran status and sex, and veteran status and race. METHODS Combined data from the 2016, 2017, and 2018 Brief Risk Factor Resilience Survey (BRFSS) from the Centers for Disease Control and Prevention (CDC) were used in this cross-sectional study. The BRFSS is conducted annually with adults via landline or cellular telephones in all 50 states in the United States, as well as in the District of Columbia, Puerto Rico, and Guam. Alcohol misuse among individuals aged 65+ was examined by veteran status and the interaction between age, race, and sex using survey-weighted logistic regression models. RESULTS Results show no interaction between veteran status and age or sex. For the interaction between veteran status and race, significant disparities were found. Black/Other race veterans were significantly more likely to engage in binge drinking and heavy drinking compared to nonveterans of the same race, White veterans, and White nonveterans. CONCLUSION Older veterans who are also Black, Indigenous and/or people of color (BIPOC) are at great risk of engaging in alcohol misuse due to the combined stressors from their intersectional identities. Interventions targeting this population should consider the historical, cultural, and systemic factors that contribute to a disproportionally higher rate of binge drinking and heavy drinking among BIPOC veterans.
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Affiliation(s)
- David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Justin McDaniel
- School of Human Sciences, Southern Illinois University, Carbondale, IL, USA
| | - Zainab Suntai
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Juliane Wallace
- School of Human Sciences, Southern Illinois University, Carbondale, IL, USA
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21
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Moskal D, Whitaker H, Bernstein J, Maisto SA, Connors GJ. Evaluation of a Web-based Psychosocial Education and Peer Support Program for Alcohol Use Concerns. ALCOHOLISM TREATMENT QUARTERLY 2021; 39:366-382. [PMID: 34326569 DOI: 10.1080/07347324.2020.1866473] [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: 10/22/2022]
Abstract
This outcomes assessment was implemented to evaluate a web-based alcohol use recovery program, Tempest Sobriety School (TSS), and to provide a model for outcome evaluation. Adults (N=541) enrolled in TSS were assessed at pre-program start and Month 2, 6, and 12. Participants reported decreased alcohol use, drug use, craving for alcohol, and alcohol use disorder symptoms over the course of the program; changes were maintained at Month 6 and 12. Participants reported sustained increases in overall physical and mental health and quality of life. Findings will inform TSS students and stakeholders and provide a model for others conducting similar evaluations.
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Affiliation(s)
| | | | | | | | - Gerard J Connors
- Clinical Research Institute on Addictions, University at Buffalo, Buffalo, NY, USA
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