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Waite MR, Heslin K, Cook J, Kim A, Simpson M. Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208933. [PMID: 36805798 DOI: 10.1016/j.josat.2022.208933] [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: 02/02/2022] [Revised: 10/11/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.
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Affiliation(s)
- Mindy R Waite
- Advocate Aurora Behavioral Health Services, Advocate Aurora Health, 1220 Dewey Ave, Wauwatosa, WI 53213, USA; Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Kayla Heslin
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Jonathan Cook
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
| | - Aengela Kim
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; Chicago Medical School, Rosalind Franklin University, 3333 Green Bay Rd, North Chicago, IL 60064, USA.
| | - Michelle Simpson
- Advocate Aurora Research Institute, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA; AAH Ed Howe Center for Health Care Transformation, Advocate Aurora Health, 960 N 12th St, Milwaukee, WI 53233, USA.
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van Duijvenbode N, VanDerNagel JE. A Systematic Review of Substance Use (Disorder) in Individuals with Mild to Borderline Intellectual Disability. Eur Addict Res 2019; 25:263-282. [PMID: 31330514 PMCID: PMC6888885 DOI: 10.1159/000501679] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022]
Abstract
Although the attention for substance use (SU) and SU disorders (SUD) among individuals with mild to borderline intellectual disability (MBID) has been growing exponentially, this form of dual diagnosis has largely been ignored by addiction medicine. In this article, we systematically review the research between January 2000 and June 2018 on the prevalence, assessment, and treatment of SU(D) among children, adolescents, and adults with MBID. A total of 138 articles were included. It is concluded that individuals with MBID are likely to be at a higher risk for developing SUD compared to those without MBID. Future research should focus on the detection of MBID among patients being treated in addiction medicine, the development and implementation of systematic assessment methods of SU(D) among individuals with MBID, and the development and evaluation of prevention and treatment interventions. System integration, interdisciplinary collaboration, and the development of tailored treatment for individuals with MBID are advised to improve treatment access and outcome for those who have developed SUD.
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Affiliation(s)
- Neomi van Duijvenbode
- Tactus, Centre for Addiction and Intellectual Disability (CAID), Deventer, The Netherlands,Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, The Netherlands,Radboud University Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands,*Neomi van Duijvenbode, Tactus, Centre for Addiction and Intellectual Disability (CAID), P.O. Box 154, NL–7400 AD Deventer (The Netherlands), E-Mail
| | - Joanne E.L. VanDerNagel
- Tactus, Centre for Addiction and Intellectual Disability (CAID), Deventer, The Netherlands,Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, The Netherlands,Radboud University Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands,Aveleijn, Borne, The Netherlands,University of Twente, Faculty of Electrical Engineering, Mathematics, and Computer Science, Human Media Interaction, Enschede, The Netherlands
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Chirikov VV, Shaya FT, Mullins CD, dosReis S, Onukwugha E, Howell CD. Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C. Expert Rev Gastroenterol Hepatol 2016; 9:1447-62. [PMID: 26524244 DOI: 10.1586/17474124.2015.1095087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection. METHODS We used Medicare claims (2006-2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively. RESULTS We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt. CONCLUSION Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.
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Affiliation(s)
- Viktor V Chirikov
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Fadia T Shaya
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.,b 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Daniel Mullins
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Susan dosReis
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Ebere Onukwugha
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Charles D Howell
- c 3 Department of Medicine, Howard University College of Medicine, 2041 Georgia Ave. Suite 5C02, Washington, DC 20060, USA
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Chirikov VV, Shaya FT, Howell CD. Contextual analysis of determinants of late diagnosis of hepatitis C virus infection in medicare patients. Hepatology 2015; 62:68-78. [PMID: 25754171 DOI: 10.1002/hep.27775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 03/04/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Patient- and county-level characteristics associated with advanced liver disease (ALD) at hepatitis C virus (HCV) diagnosis were examined in three Medicare cohorts: (1) elderly born before 1945; (2) disabled born 1945-1965; and (3) disabled born after 1965. We used Medicare claims (2006-2009) linked to the Area Health Resource Files. ALD was measured over the period of 6 months before to 3 months after diagnosis. Using weighted multivariate modified Poisson regression to address generalizability of findings to all Medicare patients, we modeled the association between contextual characteristics and presence of ALD at HCV diagnosis. We identified 1,746, 3,351, and 592 patients with ALD prevalence of 28.0%, 23.0%, and 15.0% for birth cohorts 1, 2, and 3. Prevalence of drug abuse increased among younger birth cohorts (4.2%, 22.6%, and 35.6%, respectively). Human immunodeficiency virus coinfection (prevalence ratio [PR] = 0.63; 95% confidence interval [CI]: 0.50-0.80; P = 0.001), dual Medicare/Medicaid eligibility (PR = 0.89; 95% CI: 0.80-0.98; P = 0.017), residence in counties with higher median household income (PR = 0.82; 95% CI: 0.71-0.95; P = 0.008), higher density of primary care providers (PR = 0.84; 95% CI: 0.73-0.98; P = 0.022), and more rural health clinics (PR = 0.90; 0.81-1.01; P = 0.081) were associated with lower ALD risk. End-stage renal disease (PR = 1.41; 95% CI: 1.21-1.63; P = 0.001), alcohol abuse (PR = 2.57; 95% CI: 2.33-2.84; P = 0.001), hepatitis B virus (PR = 1.32; 95% CI: 1.09-1.59; P = 0.004), and Midwest residence (PR = 1.22; 95% CI: 1.05-1.41; P = 0.010) were associated with higher ALD risk. Living in rural counties with high screening capacity was protective in the elderly, but associated with higher ALD risk among the disabled born 1945-1965. CONCLUSIONS ALD prevalence patterns were complex and were modified by race, elderly/disability status, and the extent of health care access and screening capacity in the county of residence. These study results help inform treatment strategies for HCV in the context of coordinated models of care.
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Affiliation(s)
- Viktor V Chirikov
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.,University of Maryland School of Medicine, Baltimore, MD
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van Duijvenbode N, VanDerNagel JEL, Didden R, Engels RCME, Buitelaar JK, Kiewik M, de Jong CAJ. Substance use disorders in individuals with mild to borderline intellectual disability: current status and future directions. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:319-328. [PMID: 25577182 DOI: 10.1016/j.ridd.2014.12.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/19/2014] [Indexed: 06/04/2023]
Abstract
Knowledge regarding substance use (SU) and substance use disorder (SUD) in individuals with mild to borderline intellectual disabilities (ID) has increased over the last decade, but is still limited. Data on prevalence and risk factors are fragmented, and instruments for screening and assessment and effective treatment interventions are scarce. Also, scientific developments in other fields are insufficiently incorporated in the care for individuals with ID and SUD. In this selective and critical review, we provide an overview of the current status of SU(D) in ID and explore insights on the conceptualisation of SUD from other fields such as addiction medicine and general psychiatry. SU(D) turns out to be a chronic, multifaceted brain disease that is intertwined with other physical, psychiatric and social problems. These insights have implications for practices, policies and future research with regard to the prevalence, screening, assessment and treatment of SUD. We will therefore conclude with recommendations for future research and policy and practice, which may provide a step forward in the care for individuals with ID and SUD.
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Affiliation(s)
- Neomi van Duijvenbode
- Radboud University Nijmegen, Behavioural Science Institute, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands.
| | - Joanneke E L VanDerNagel
- Aveleijn, Grotestraat 260, 7622 GW Borne, The Netherlands; Tactus, Raiffeisenstraat 75, 7514 AM Enschede, The Netherlands; Radboud University Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands
| | - Robert Didden
- Radboud University Nijmegen, Behavioural Science Institute, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands; Trajectum, P.O. Box 40012, 8004 DA Zwolle, The Netherlands
| | - Rutger C M E Engels
- Radboud University Nijmegen, Behavioural Science Institute, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands; Trimbos Institute, P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Nijmegen Centre for Evidence-based Medicine, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marion Kiewik
- Aveleijn, Grotestraat 260, 7622 GW Borne, The Netherlands; Radboud University Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands
| | - Cor A J de Jong
- Radboud University Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands
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Reichard A, Fox MH. Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults. Disabil Health J 2013; 6:75-86. [PMID: 23507157 PMCID: PMC4478586 DOI: 10.1016/j.dhjo.2012.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 11/16/2012] [Accepted: 12/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals dually eligible for Medicaid and Medicare constitute a small percentage of these program's populations but account for a disproportionately large percent of their total costs. While much work has examined high expenditures, little is known about their health and details of their health care utilization. OBJECTIVE/HYPOTHESIS Utilize an important public health surveillance tool to better understand preventive service use among the dual eligible population. METHODS This study involved descriptive and regression analyses of dual eligibles in the Medical Expenditure Panel Survey data from pooled alternate years 2000-2008. We classified the sample into 4 mutually exclusive groups: cognitive limitations, physical disabilities, double diagnosis (cognitive limitations and physical disability), or neither cognitive limitations nor physical disability. RESULTS For most groups, age was significantly associated with preventive services, though direction varies. Older age was linked to greater receipt of flu shots while younger age was associated with greater receipt of Pap tests, mammograms and dental services. Black women in all groups (except cognitive limitations) had an increased likelihood of receiving a Pap test and a mammogram. CONCLUSIONS A subset of dual eligibles drives the majority of expenditures. People with physical disabilities, regardless of whether they also have a cognitive limitation, are among the highest costing and sickest of our non-institutionalized dual eligible population. Efforts to understand and address the challenges faced by women with physical disabilities in accessing Pap tests or mammograms may be helpful in improving the overall health status for this disability group, but also for all dual eligibles.
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Affiliation(s)
- Amanda Reichard
- University of Kansas, Research and Training Center on Independent Living, 1000 Sunnyside Ave., Suite 4089, Lawrence, KS 66045, United States
| | - Michael H. Fox
- Division of Human Development and Disability (DHDD), National Center on Birth Defects and Developmental Disabilities (NCBDDD), Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, MS-E88, Atlanta, Georgia 30333, United States
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