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Muench U, Fraze TK. The Future of Behavioral Health-Harnessing the Potential of Psychiatric Mental Health Nurse Practitioners. JAMA Netw Open 2022; 5:e2224365. [PMID: 35904788 DOI: 10.1001/jamanetworkopen.2022.24365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ulrike Muench
- School of Nursing, Department of Social and Behavioral Sciences, University of California, San Francisco
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Healthforce Center, School of Medicine, University of California, San Francisco
| | - Taressa K Fraze
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Healthforce Center, School of Medicine, University of California, San Francisco
- School of Medicine, Department of Family and Community Medicine, University of California, San Francisco
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Richard JV, Huskamp HA, Barnett ML, Busch AB, Mehrotra A. A methodology for identifying behavioral health advanced practice registered nurses in administrative claims. Health Serv Res 2022; 57:973-978. [PMID: 35332555 PMCID: PMC9264473 DOI: 10.1111/1475-6773.13974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE (STUDY QUESTION) Advance practice registered nurses (APRNs) play an increased role in mental illness treatment. Health services research that uses claims to study mental health is often limited because behavioral health nurse practitioners (i.e., APRNs who specialize in mental illness also known as psychiatric mental health APRNs) cannot be easily identified in claims data. We describe a methodology to identify behavioral health APRNs in administrative claims. DATA SOURCES/STUDY SETTING (W/ HOSPITAL/INSTITUTION SETTING ANONYMIZED): We use 2010-2018 claims from the traditional Medicare fee-for-service program along with 2010-2019 commercial claims and Medicare Advantage data from the OptumLabs® Data Warehouse (OLDW). Self-reported specialty data from the National Plan & Provider Enumeration System (NPPES) were used for validation. STUDY DESIGN For each APRN, we calculated the percentage of visit diagnoses and of prescriptions in each database that were for mental health and classified those with ≥80% as behavioral health APRNs. We validated our definition with NPPES self-reported specialty for Medicare data. DATA COLLECTION / EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS Among APRNs with 10+ visits, 10,978 (8.1%) in Medicare and 9829 (11.7%) in commercial claims data met our visit-based criteria as behavioral health APRNs. Among APRNs with 10+ prescriptions, 8160 (6.2%) in Medicare and 16,538 (9.0%) in commercial claims data met our prescription-based criteria as behavioral health APRNs. Among the APRNs who self-reported they were behavioral health APRNs, 92.8% and 90.5% met our visit-based and prescription-based criteria respectively. CONCLUSIONS We present and validate two methods of identifying behavioral health APRNs in claims that can be used by other researchers.
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Affiliation(s)
- Jessica V Richard
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States
| | - Michael L Barnett
- Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, Massachusetts, United States.,Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States.,McClean Hospital, Belmont, Massachusetts, United States
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts, United States.,Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Lester TR, Bannett Y, Gardner RM, Feldman HM, Huffman LC. Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study. Front Pediatr 2022; 10:794722. [PMID: 35372169 PMCID: PMC8970594 DOI: 10.3389/fped.2022.794722] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To describe medication management of children diagnosed with anxiety and/or depression by primary care providers within a primary care network. Study Design/Methods We performed a retrospective cross-sectional analysis of electronic health record (EHR) structured data from all children seen at least twice in a 4-year observation period within a network of primary care clinics in Northern California. For children who had visit diagnoses of anxiety, depression, anxiety+depression or symptoms characteristic of these conditions, we analyzed the rates and types of medications prescribed. A logistic regression model considered patient variables for the combined sample. Results Of all patients 6-18 years old (N = 59,484), 4.4% (n = 2,635) had a diagnosis of anxiety only, 2.4% (n = 1,433) depression only, and 1.2% (n = 737) both anxiety and depression (anxiety + depression); 18% of children with anxiety and/or depression had comorbid ADHD. A total of 15.0% with anxiety only (n = 357), 20.5% with depression only (n = 285), and 47.4% with anxiety+depression (n=343) were prescribed a psychoactive non-stimulant medication. For anxiety and depression only, the top three medications prescribed were sertraline, fluoxetine, and citalopram. For anxiety + depression, the top three medications prescribed were citalopram, sertraline, and escitalopram. Frequently prescribed medications also included benzodiazepines. Logistic regression modeling showed that the depression only and anxety + depression categories had increased likelihood of medication prescription. Older age and mental health comorbidities were independently associated with increased likelihood of medication prescription. Conclusions In this network, ~8% of children carried a diagnosis of anxiety and/or depression. Medication choices generally aligned with current recommendations with the exception of use of benzodiazepines.
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Affiliation(s)
- Talia R. Lester
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Yair Bannett
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Rebecca M. Gardner
- Quantitative Science Unit, Department of Medicine, Stanford School of Medicine, Palo Alto, CA, United States
| | - Heidi M. Feldman
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lynne C. Huffman
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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Mills J. Lithium: The Oldest-Known Metal in the Universe Can Prevent Suicide, and Nurses Should Be Using It More. Issues Ment Health Nurs 2022; 43:193-197. [PMID: 34797752 DOI: 10.1080/01612840.2021.1990584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, a Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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Kverno K. Lithium: Current Clinical Guidelines for Nurse Practitioners. J Psychosoc Nurs Ment Health Serv 2022; 60:6-9. [PMID: 34978941 DOI: 10.3928/02793695-20211207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bipolar disorder is a serious neuroprogressive disorder associated with structural and functional brain changes, multiple comorbidities, and heightened risk for suicide. Lithium has been a first-line treatment for bipolar disorder for more than 50 years and recent research suggests that early identification and treatment of bipolar disorder with lithium can alter the progression of the illness. The purpose of the current article is to review evidence for lithium's neurotrophic and neuroprotective actions and clinical guidelines for safe and effective use. [Journal of Psychosocial Nursing and Mental Health Services, 60(1), 6-9.].
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Yang BK, Idzik S, Evans P. Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study. Int J Nurs Stud 2021; 120:103956. [PMID: 34091256 DOI: 10.1016/j.ijnurstu.2021.103956] [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: 08/31/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians. OBJECTIVES To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication initiation differs among youths treated by provider and specialty type. DESIGN A retrospective cohort study. SETTINGS We used Medicaid-insurance claims data in one mid-Atlantic state in the US. PARTICIPANTS A total 12,991 Medicaid-insured youths aged 0-20 years who started psychotropic medications prescribed by nurse practitioners or physicians with primary care or psychiatric specialty during 2013-2014. METHODS Providers were grouped into nurse practitioners and physicians and into primary care and psychiatric specialty. Descriptive statistics were performed to compare each class of psychotropic medications initiated and psychiatric diagnoses of enrollees according to provider type within each specialty. Using multinomial logistic regression with psychiatrists as a reference group, we estimated the odds of having a type of prescriber for psychotropic medication initiation for youths who received psychosocial services prior to a new start of the medication and concurrently, compared to that for those who did not, after adjusting for patients' demographic characteristics and diagnosis. RESULTS Youths served by nurse practitioners resided in small and non-metropolitan areas significantly more often than those served by their physician counterparts. There was no major difference in a class of psychotropic medications initiated by nurse practitioners and physicians within each specialty type, except a higher proportion of antidepressants (13.5% versus 10.5%) and a lower proportion of attention deficit hyperactivity disorder medications prescribed (68.8% versus 74.0%) by primary care nurse practitioners compared to their physician counterparts. Youths who received psychosocial services prior to medication initiation were less likely to have primary care physicians (Adjusted odds ratio=0.15, 95% confidence interval=0.82, 1.33) or primary care nurse practitioners (Adjusted odds ratio=0.16, 95% confidence interval=0.12, 0.20) as their initiating prescriber than those who did not. CONCLUSIONS Youths treated by nurse practitioners and physicians with or without psychiatric specialty showed unique patterns of mental health service use. Our findings can be used to build effective collaborations among provider and specialty type for quality of mental health services delivered to targeted populations in need.
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Affiliation(s)
- Bo Kyum Yang
- Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA.
| | - Shannon Idzik
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA
| | - Paige Evans
- Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA
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Meadows AL, Strickland JC, Qalbani S, Conner KL, Su A, Rush CR. Comparing Changes in Controlled Substance Prescribing Trends by Provider Type. Am J Addict 2020; 29:35-42. [PMID: 31600029 PMCID: PMC6941737 DOI: 10.1111/ajad.12962] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Forty-nine out of 50 states have implemented Prescription Drug Monitoring Programs (PDMPs) to monitor controlled substance (CS) prescribing. PDMPs change health care provider behavior, but few studies have examined changes in CS prescription by health care provider type. METHODS Aggregated yearly data, including number of CS prescriptions, doses, and doses per prescription by health care provider type (physician, advanced practice registered nurse [APRN], and dentist) for each year from 2011 to 2017 was provided by the state PDMP, Kentucky All Schedule Prescription Electronic Reporting System (KASPER). In aggregate, this data set included 64,578,307 total prescriptions and 3,982,130,994 total doses of Schedule II-V medications. RESULTS Physicians and dentists showed a trend of decreasing prescriptions and doses for Schedule II opioids from 2012 to 2017 (27-32% reduction in 2017 compared to 2011). APRNs showed a substantive increase in the number of doses and prescriptions (121-204% increase in 2017 compared to 2011), with increases remaining when controlling for number of providers. Physicians increased doses and prescriptions of Schedule II stimulants (37% increase for both doses and prescriptions), but by a smaller magnitude than APRN increases in stimulants (334-360% increase). Dentists showed decreases in Schedule II stimulants prescribed (69-80% reduction). Similar trends, but more modest in magnitude, were observed for Schedule III-IV. DISCUSSION AND CONCLUSIONS Although monitoring and continuing education requirements are similar across all providers in Kentucky, differences in prescription trends for Schedule II opioids and stimulants were noted for physicians, APRNs, and dentists. SCIENTIFIC SIGNIFICANCE Changes in prescribing following introduction of mandatory use of KASPER markedly differed based on provider type, with increases observed for APRNs compared with physicians and dentists. These findings advance prior research by providing a detailed examination of prescribing trends by provider type subsequent to a PDMPs mandatory use law. (Am J Addict 2019;00:00-00).
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Affiliation(s)
- Amy Lynn Meadows
- University of Kentucky College of Medicine Department of Psychiatry, 245 Fountain Court, Suite 225, Lexington KY 40509
| | - Justin C. Strickland
- University of Kentucky College of Arts and Sciences, Department of Psychology, Lexington, KY
| | - Shiraz Qalbani
- River Valley Behavioral Health, 1100 Walnut St. PO BOX 1637, Owensboro, KY 42302
| | - Kailyn L. Conner
- University of Kentucky College of Pharmacy, 789 S Limestone St, Lexington, KY 40506
| | - Amanda Su
- University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536
| | - Craig R. Rush
- University of Kentucky College of Medicine Department of Psychiatry, 245 Fountain Court, Suite 225, Lexington KY 40509
- University of Kentucky College of Medicine Department of Behavioral Science, Lexington, KY
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Jeong S, Kang C, Cho H, Kang HJ, Jang S. Socioeconomic determinants affecting the access and utilization of depression care services in immigrants: A population-based study. PLoS One 2019; 14:e0213020. [PMID: 30865684 PMCID: PMC6415893 DOI: 10.1371/journal.pone.0213020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 02/13/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is imperative to address the health problems faced by immigrants in their destination countries in light of the current magnitude of migration processes worldwide. We aimed to evaluate the socioeconomic determinants of healthcare utilization in immigrants with depression. METHOD A population-based cohort comprising all immigrants who were eligible for National Health Insurance coverage (permanent residents, marriage immigrants, and naturalized citizens) using the National Health Insurance Claims Database in 2011-2013 was established. Cases were defined as immigrants with new-onset depression. Controls were new-onset Korean patients with depression matched by age, sex, and Charlson comorbidity index in a 1:2 ratio. Appropriateness of care (AOC) was defined as visiting a clinic for depression management at least 3 times in the first 12 weeks and 4 times thereafter until 12 months post-cohort entry. RESULTS A total of 2,378 immigrants and 4,756 matched Korean patients were identified. Of the immigrants, 30.0% achieved AOC, in contrast to 38.7% of Koreans (p < .0001). Adjusting for possible covariates, AOC was less likely for immigrants (adjusted OR (aOR), 0.760; 95% CI: 0.670-0.863). Medical Aid (aOR, 2.309; 95% CI, 1.479-3.610), rural residence (aOR, 1.536; 95% CI, 1.054-2.237), the presence of a psychiatric comorbidity (aOR, 1.912; 95% CI, 1.484-2.463), and visiting a psychiatrist (aOR, 2.387; 95% CI, 1.821-3.125) were associated with an increased likelihood of AOC in immigrants. CONCLUSION Socioeconomic determinants included insurance type (Medical Aid and National Health Insurance), place of residence, psychiatric comorbid status, doctor specialty, easy access to medical services (clinic-based), and a SSRI-based treatment regimen. Those predictors should be taken into account when developing healthcare strategies for immigrants.
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Affiliation(s)
- Sohyun Jeong
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Cinoo Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hyemin Cho
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
| | - Hee-Jin Kang
- Big Data Steering Department of National Health Insurance Service, Wonju, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
- * E-mail:
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