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Hadinata IE, Naren T, Rowland B, Cook J, Nielsen S. Do video or telephone consultations impact attendance rates in an addiction medicine specialist outpatient clinic? Intern Med J 2024; 54:1490-1496. [PMID: 38934477 DOI: 10.1111/imj.16462] [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: 04/14/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity and reduce costs to the community. Telehealth has previously been proven effective at delivering AOD treatment in the right settings. Yet, Australia's current Medicare funding restricts telephone consultations. AIM We hypothesise that treatment modality influences attendance rates. Specifically, telephone consultations can remove barriers to accessing treatment and, therefore, can increase attendance. METHODS We conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 to 30 June 2023. A mixed-effects logistic regression model was used to analyse factors associated with attendance rates. RESULTS There were 576 participants in the study, and 3354 appointments were booked over the 12-month study period. Of these, 2695 were face-to-face, 541 were telephone and 118 were video. The unadjusted raw attendance rate was highest in the telephone group (87.24%), followed by face-to-face (73.02%) and video (44.92%). After adjusting for covariates, telephone consultation was associated with significantly increased odds of attending compared to face-to-face (odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.90-3.54, P < 0.001). Video consultation was associated with a 69% reduction in the odds of attending compared to face-to-face (OR = 0.31, 95% CI = 0.019-0.49, P < 0.001). CONCLUSIONS While physical attendance may be required for specific clinical care, telephone consultations are associated with increased attendance and can form an important adjunct to delivering addiction treatment. Given the substantial costs of substance use disorders, this could inform government policies and funding priorities to further improve access and treatment outcomes.
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Affiliation(s)
- Ignatius E Hadinata
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Alcohol and Other Drugs Committee, Victoria Faculty, Royal Australian College of General Practitioners, Melbourne, Victoria, Australia
| | - Thileepan Naren
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Bosco Rowland
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Clinical and Social Research Team, Turning Point, Melbourne, Victoria, Australia
- Faculty of Health, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Cook
- Department of Addiction Medicine, Western Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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Holt AG, Hussong A, Castro MG, Bossenbroek Fedoriw K, Schmidt AM, Prentice A, Ware OD. Smoking Policies of Outpatient and Residential Substance Use Disorder Treatment Facilities in the United States. Tob Use Insights 2024; 17:1179173X241254803. [PMID: 38752184 PMCID: PMC11095085 DOI: 10.1177/1179173x241254803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/28/2024] [Indexed: 05/18/2024] Open
Abstract
Tobacco use is associated with morbidity and mortality. Many individuals who present to treatment facilities with substance use disorders (SUDs) other than tobacco use disorder also smoke cigarettes or have a concomitant tobacco use disorder. Despite high rates of smoking among those with an SUD, and numerous demonstrated benefits of comprehensive SUD treatment for tobacco use in addition to co-occurring SUDs, not all facilities address the treatment of comorbid tobacco use disorder. In addition, facilities vary widely in terms of tobacco use policies on campus. This study examined SUD facility smoking policies in a national sample of N = 16,623 SUD treatment providers in the United States in 2021. Most facilities with outpatient treatment (52.1%) and facilities with residential treatment (67.8%) had a smoking policy that permitted smoking in designated outdoor area(s). A multinomial logistic regression model found that among facilities with outpatient treatment (n = 13,778), those located in a state with laws requiring tobacco free grounds at SUD facilities, those with tobacco screening/education/counseling services, and those with nicotine pharmacotherapy were less likely to have an unrestrictive tobacco smoking policy. Among facilities with residential treatment (n = 3449), those with tobacco screening/education/counseling services were less likely to have an unrestrictive tobacco smoking policy. There is variability in smoking policies and tobacco use treatment options in SUD treatment facilities across the United States. Since tobacco use is associated with negative biomedical outcomes, more should be done to ensure that SUD treatment also focuses on reducing the harms of tobacco use.
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Affiliation(s)
- Alison G. Holt
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrea Hussong
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Gabriela Castro
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Amy Prentice
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Orrin D. Ware
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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3
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Fardone E, Montoya ID, Schackman BR, McCollister KE. Economic benefits of substance use disorder treatment: A systematic literature review of economic evaluation studies from 2003 to 2021. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209084. [PMID: 37302488 PMCID: PMC10530001 DOI: 10.1016/j.josat.2023.209084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 04/02/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The economic burden of substance use disorder (SUD) is significant, comprising costs of health care and social services, criminal justice resources, loss of productivity, and premature mortality. This study assembles and synthesizes two decades of evidence describing the benefits of SUD treatment across five main outcome domains; 1) health care utilization; 2) self-reported criminal activity by offense type; 3) criminal justice involvement collected from administrative records or self-reported; 4) productivity assessed through working hours or wages earned; and 5) social services (e.g., a day spent in transitional housing). METHODS This review included studies if they reported the monetary value of the intervention outcomes, most commonly through a cost-benefit or cost-effectiveness framework. The search included studies from 2003 to the present day as of this writing (up to October 15, 2021). Summary cost estimates were adjusted using the US Consumer Price Index (CPI) to reflect the 12-month benefits per client in USD 2021. We followed the PRISMA methodology for study selection and assessed quality using the Checklist for Health Economic Evaluation Reporting Standards (CHEERS). RESULTS The databases yielded 729 studies after removing duplicates, and we ultimately selected 12 for review. Studies varied widely regarding analytical approaches, time horizons, outcome domains, and other methodological factors. Among the ten studies that found positive economic benefits, reductions in criminal activity or criminal justice costs represented the largest or second largest component of these benefits (range $621 to $193,440 per client). CONCLUSIONS Consistent with previous findings, a reduction in criminal activity costs is driven by the relatively high societal cost per criminal offense, notably for violent crimes, such as aggravated assault and rape/sexual assault. Accepting the economic rationale for increased investment in SUD interventions will require recognizing that more benefits accrue to individuals by avoiding being victims of a crime than to governments through budget offsets resulting from savings in non-SUD program expenses. Future studies should explore individually tailored interventions to optimize care management, which may yield unexpected economic benefits to services utilization, and criminal activity data to estimate economic benefits across a broad range of interventions.
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Affiliation(s)
- Erminia Fardone
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America.
| | - Iván D Montoya
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America
| | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York United States of America
| | - Kathryn E McCollister
- Department of Public Health Sciences, Division of Health Services Research and Policy, University of Miami-Miller School of Medicine, United States of America
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Slocum S, Paquette CE, Pollini RA. Drug treatment perspectives and experiences among family and friends of people who use illicit opioids: A mixed methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209023. [PMID: 36940779 DOI: 10.1016/j.josat.2023.209023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Increasing evidence-based treatment for opioid use disorder (OUD) is key to reducing opioid-related morbidity and mortality. Family and close friends of people with OUD can play an important role in motivating and facilitating their loved ones' treatment. We examined evolving knowledge about OUD and its treatment among family and close friends of people who use illicit opioids and their experiences navigating the treatment system. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids in the past 30 days, and had a close relationship with someone who currently uses illicit opioids. Recruitment leveraged a nonprofit support network for family members of persons with a substance use disorder (SUD). We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22, April-July 2018) informed the development of a quantitative survey (N = 260, February-July 2020). Attitudes and experiences related to OUD treatment constituted an emergent theme in qualitative interviews, which informed a section of the subsequent survey. RESULTS Both qualitative and quantitative data indicated support groups were instrumental in increasing OUD knowledge and influencing attitudes toward treatment options. Regarding how best to motivate drug treatment engagement, some participants favored what they referred to as a "tough love" approach that typically included a preference for abstinence-based treatment, while others favored a positive reinforcement approach focused on enhancing treatment motivation. Loved ones' treatment preferences and scientific evidence played a minor role in determining preferred treatment modalities, and only 38 % of survey participants believed that using medications for OUD is more effective than treatment without medications. A majority (57 %) agreed that finding a drug treatment slot or bed was either somewhat or very difficult, and that once in the system treatment was costly and involved multiple returns to treatment after relapse. CONCLUSIONS Support groups appear to be important forums for gaining knowledge about OUD, negotiating strategies to motivate their loved ones' entry into treatment, and forming preferences for treatment modalities. Participants emphasized the influence of other group members more so than their loved ones' preferences or empirical evidence of effectiveness with regard to choosing treatment programs and approaches.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States of America
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States of America; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States of America.
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Hornack SE, Yates BT. Costs, benefits, and net benefit of 13 inpatient substance use treatments for 14,947 women and men. EVALUATION AND PROGRAM PLANNING 2023; 97:102198. [PMID: 36702008 DOI: 10.1016/j.evalprogplan.2022.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 01/31/2020] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
In an attempt to replicate earlier findings that substance use disorder treatment (SUDTx) has monetary outcomes (benefits) for taxpayers that exceed treatment costs several times over for the average participant, costs of SUDTx were contrasted to observed costs of healthcare, criminal justice services, and economic assistance, plus potential increases in earned income, for 14,947 substance-using individuals treated at 13 intensive inpatient programs varying in gender sensitivity. Those who received higher levels of gender-sensitive treatment were expected to better offset treatment costs through greater reductions in subsequent service costs and economic assistance, and greater increases in earned income. Compared to the 24 months preceding treatment, archival data from state databases showed that use of health and criminal justice services, and receipt of economic assistance, actually increased during the 24 months following treatment, and that earned income decreased, resulting in unexpectedly negative net benefits, i.e., a net loss, from a taxpayer perspective. More gender-sensitive treatment was less costly per participant, however, making the net loss less for persons receiving more gender-sensitive treatment. Alternative explanations for these findings are explored, including utilization of archival records of service use rather than the more bias-sensitive self-reports of service use that others have examined previously. The importance of evaluating nonmonetary, as well as monetary, outcomes of substance use disorder (SUD) treatment is noted as well.
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Affiliation(s)
- Sarah E Hornack
- Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062, USA.
| | - Brian T Yates
- Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062, USA
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Evans EA, Delorme E, Cyr KD, Geissler KH. The Massachusetts public health data warehouse and the opioid epidemic: A qualitative study of perceived strengths and limitations for advancing research. Prev Med Rep 2022; 28:101847. [PMID: 35669857 PMCID: PMC9166413 DOI: 10.1016/j.pmedr.2022.101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 12/17/2022] Open
Abstract
The Massachusetts Public Health Data Warehouse is a public health innovation. We assessed the utility of this big data resource for research on the opioid epidemic. Big data have many advantages and limitations for opioid epidemic research. Findings can help to maximize the advantages of big data and avoid inappropriate use. Lessons learned can aid other states to establish big data for public health.
Due to the opioid overdose epidemic, Massachusetts created a Public Health Data Warehouse, encompassing individually-linked administrative data on most of the population as provided by more than 20 systems. As others seek to assemble and mine big data on opioid use, there is a need to consider its research utility. To identify perceived strengths and limitations of administrative big data, we collected qualitative data in 2019 from 39 stakeholders with knowledge of the Massachusetts Public Health Data Warehouse. Perceived strengths included the ability to: (1) detect new and clinically significant relationships; (2) observe treatments and services across institutional boundaries, broadening understanding of risk and protective factors, treatment outcomes, and intervention effectiveness; (3) use geographic-specific lenses for community-level health; (4) conduct rigorous “real-world” research; and (5) generate impactful findings that legitimize the scope and impacts of the opioid epidemic and answer urgent questions. Limitations included: (1) oversimplified information and imprecise measures; (2) data access and analysis challenges; (3) static records and substantial lag times; and (4) blind spots that bias or confound results, mask upstream or root causes, and contribute to incomplete understanding. Using administrative big data to conduct research on the opioid epidemic offers advantages but also has limitations which, if unrecognized, may undermine its utility. Findings can help researchers to capitalize on the advantages of big data, and avoid inappropriate uses, and aid states that are assembling big data to guide public health practice and policy.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Elizabeth Delorme
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Karl D Cyr
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Kimberley H Geissler
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Expanding the continuum of substance use disorder treatment: Nonabstinence approaches. Clin Psychol Rev 2022; 91:102110. [PMID: 34864497 PMCID: PMC8815796 DOI: 10.1016/j.cpr.2021.102110] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
Only a small minority of people with substance use disorders (SUDs) receive treatment. A focus on abstinence is pervasive in SUD treatment, defining success in both research and practice, and punitive measures are often imposed on those who do not abstain. Most adults with SUD do not seek treatment because they do not wish to stop using substances, though many also recognize a need for help. This narrative review considers the need for increased research attention on nonabstinence psychosocial treatment of SUD - especially drug use disorders - as a potential way to engage and retain more people in treatment, to engage people in treatment earlier, and to improve treatment effectiveness. We describe the development of nonabstinence approaches within the historical context of SUD treatment in the United States, review theoretical and empirical rationales for nonabstinence SUD treatment, and review existing models of nonabstinence psychosocial treatment for SUD among adults to identify gaps in the literature and directions for future research. Despite significant empirical support for nonabstinence alcohol interventions, there is a clear gap in research examining nonabstinence psychosocial treatment for drug use disorders. Future research must test the effectiveness of nonabstinence treatments for drug use and address barriers to implementation.
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Gold HT, McDermott C, Hoomans T, Wagner TH. Cost data in implementation science: categories and approaches to costing. Implement Sci 2022; 17:11. [PMID: 35090508 PMCID: PMC8796347 DOI: 10.1186/s13012-021-01172-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022] Open
Abstract
A lack of cost information has been cited as a barrier to implementation and a limitation of implementation research. This paper explains how implementation researchers might optimize their measurement and inclusion of costs, building on traditional economic evaluations comparing costs and effectiveness of health interventions. The objective of all economic evaluation is to inform decision-making for resource allocation and to measure costs that reflect opportunity costs—the value of resource inputs in their next best alternative use, which generally vary by decision-maker perspective(s) and time horizon(s). Analyses that examine different perspectives or time horizons must consider cost estimation accuracy, because over longer time horizons, all costs are variable; however, with shorter time horizons and narrower perspectives, one must differentiate the fixed and variable costs, with fixed costs generally excluded from the evaluation. This paper defines relevant costs, identifies sources of cost data, and discusses cost relevance to potential decision-makers contemplating or implementing evidence-based interventions. Costs may come from the healthcare sector, informal healthcare sector, patient, participant or caregiver, and other sectors such as housing, criminal justice, social services, and education. Finally, we define and consider the relevance of costs by phase of implementation and time horizon, including pre-implementation and planning, implementation, intervention, downstream, and adaptation, and through replication, sustainment, de-implementation, or spread.
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Simes JT, Jahn JL. The consequences of Medicaid expansion under the Affordable Care Act for police arrests. PLoS One 2022; 17:e0261512. [PMID: 35020737 PMCID: PMC8754343 DOI: 10.1371/journal.pone.0261512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND & METHODS National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including "defunding the police," a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014-2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. RESULTS Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20-32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25-41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19-29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24-28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. CONCLUSIONS Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.
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Affiliation(s)
- Jessica T. Simes
- Department of Sociology, Boston University, Boston, MA, United States of America
| | - Jaquelyn L. Jahn
- Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States of America
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Corredor-Waldron A, Currie J. "Tackling the Substance Use Disorder Crisis: The Role of Access to Treatment Facilities". JOURNAL OF HEALTH ECONOMICS 2022; 81:102579. [PMID: 34990993 DOI: 10.1016/j.jhealeco.2021.102579] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/06/2021] [Accepted: 12/15/2021] [Indexed: 06/14/2023]
Abstract
The continuing drug overdose crisis in the U.S. has highlighted the urgent need for greater access to treatment. This paper examines the impact of openings and closings of substance use disorder treatment facilities in New Jersey on emergency room visits for substance use disorder issues among nearby residents. We find that drug-related ER visits increase by 7.4% after a facility closure and decrease by 6.5% after an opening. The effects are smaller for the middle aged than for either younger or older people, and are also somewhat larger for Black residents, and for those on Medicaid. The results suggest that expanding access to treatment results in significant reductions in morbidity related to drugs.
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11
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Henke RM, Head MA, Camacho-Cook J, Lin JR, Carroll CD. Cost Offsets of Treatment for Serious Mental Illness and Substance Use Disorder. Psychiatr Serv 2021; 72:1006-1011. [PMID: 33971721 DOI: 10.1176/appi.ps.201900445] [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: 12/01/2022]
Abstract
OBJECTIVE The authors examined whether timely treatment for serious mental illness and substance use disorder reduces overall health care costs in a 3-year period. METHODS Claims data from the IBM MarketScan Research Databases (2010-2017) were analyzed. The population studied included 2,997 Medicaid enrollees and 35,805 commercial insurance enrollees ages 18-64 years with an index event for a serious mental illness and 2,315 Medicaid enrollees and 28,419 commercial insurance enrollees with an index event for a substance use disorder. Health care costs in the 3 years after an index event were calculated for enrollees who received care that met a minimum threshold for treatment and for those who did not receive such care. The Toolkit for Weighting and Analysis of Nonequivalent Groups was used to control for statistically significant differences in pretreatment characteristics between the groups. RESULTS All health care spending for enrollees who were engaged in behavioral health treatment for substance use disorder or a serious mental illness increased from year 0 to year 1 but decreased faster than the spending of enrollees who were not engaged in treatment, with larger trends for those engaged in substance use disorder treatment. Expenses for inpatient and emergency department care decreased over the 3 follow-up years; however, spending on outpatient services was significantly higher in all 3 follow-up years for those engaged in treatment. CONCLUSIONS Health care delivery and payment models that improve access to behavioral health treatment may reduce emergency department, inpatient, and overall health care costs for particular subpopulations.
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Affiliation(s)
- Rachel Mosher Henke
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Michael A Head
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Jessica Camacho-Cook
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Janice R Lin
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
| | - Christopher D Carroll
- IBM Watson Health, Cambridge, Massachusetts (Henke, Head, Camacho-Cook); IBM Watson Health, Bethesda, Maryland (Lin); Substance Abuse and Mental Health Services Administration, Rockville, Maryland (Carroll)
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12
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Belete H, Ali T, Mekonen T, Fekadu W, Belete T. Perceived stigma and associated factors among adults with problematic substance use in Northwest Ethiopia. Psychol Res Behav Manag 2021; 14:637-644. [PMID: 34093046 PMCID: PMC8169083 DOI: 10.2147/prbm.s301251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Substance use-related problems including cigarette smoking and alcohol use are among leading preventable risk factors for premature death. However, people with these problems did not get the appropriate treatment they need. Stigma against substance use could be the potential barrier for people with problematic substance use to seek professional help. Therefore, the objective of this study was to investigate magnitude and associated factors of perceived stigma towards problematic substance use. Methods A total of 2400 participants were screened using the Cut down, Annoyed, Guilty, and Eye-opener (CAGE) Adapted to Include Drugs (CAGE-AID) questionnaire. We found 540 participants screened positive for problematic substance use (alcohol, hashish, tobacco and khat) and interviewed them for perceived stigma using Perceived Stigma of Substance Abuse Scale (PSAS). Logistic regression was used to examine associated factors with perceived stigma. Results Three hundred forty-five (63.9%) participants reported perceived stigma above the mean value of Perceived Stigma of Substance Abuse Scale (PSAS). Variables positively associated with perceived stigma were lower wealth and joblessness, history of separation from family members before age of 18 years, poly-substance misuse and awareness about economic crisis of substance use. Conclusion Approximately, three in five people with problematic substance use perceived having been stigmatized by others. Health planning for problematic substance use should focus on stigma.
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Affiliation(s)
- Habte Belete
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfa Mekonen
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubalem Fekadu
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Psychiatry Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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13
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Saloner B, Maclean JC. Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion. Health Aff (Millwood) 2021; 39:453-461. [PMID: 32119615 DOI: 10.1377/hlthaff.2019.01428] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Affordable Care Act's Medicaid expansion provided insurance coverage to many low-income adults with substance use disorders, but it is unclear whether this led to more people receiving treatment. We used the Treatment Episode Data Set and a difference-in-differences approach to compare annual rates of specialty treatment admissions in expansion versus nonexpansion states in the period 2010-17. We found that admissions to treatment steadily increased in the four years after Medicaid expansion, with 36 percent more people entering treatment by the fourth expansion year in expansion states compared to nonexpansion states. Changes were largest for people entering intensive outpatient programs and those seeking medication treatment for opioid use disorder. The share of admissions paid for by Medicaid increased 23 percentage points in expansion states compared to nonexpansion states, largely displacing treatment paid for by state and local governments. The gradual increase in specialty substance use disorder treatment admissions after Medicaid expansion may reflect improving capacity and access to care.
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Affiliation(s)
- Brendan Saloner
- Brendan Saloner ( bsaloner@jhu. edu ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Johanna Catherine Maclean
- Johanna Catherine Maclean is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania, and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
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Kacmarek CN, Yates BT, Nich C, Kiluk BD. A pilot economic evaluation of computerized cognitive behavioral therapy for alcohol use disorder as an addition and alternative to traditional therapy. Alcohol Clin Exp Res 2021; 45:1109-1121. [PMID: 33730384 PMCID: PMC8131237 DOI: 10.1111/acer.14601] [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: 06/25/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computer-based delivery of cognitive behavioral therapy (CBT) may be a less costly approach to increase dissemination and implementation of evidence-based treatments for alcohol use disorder (AUD). However, comprehensive evaluations of costs, cost-effectiveness, and cost-benefit of computer-delivered interventions are rare. METHODS This study used data from a completed randomized clinical trial to evaluate the cost-effectiveness and cost-benefit of a computer-based version of CBT (CBT4CBT) for AUD. Sixty-three participants were randomized to receive one of the following treatments at an outpatient treatment facility and attended at least one session: (1) treatment as usual (TAU), (2) CBT4CBT plus treatment as usual (CBT4CBT+TAU), or (3) CBT4CBT plus brief monitoring. RESULTS Median protocol treatment costs per participant differed significantly between conditions, Kruskal-Wallis H(2) = 8.40, p = 0.02, such that CBT4CBT+TAU and CBT4CBT+monitoring each cost significantly more per participant than TAU. However, when nonprotocol treatment costs were included, total treatment costs per participant did not differ significantly between conditions. Median incremental cost-effective ratios (ICERs) revealed that CBT4CBT+TAU was more costly and more effective than TAU. It cost $35.08 to add CBT4CBT to TAU to produce a reduction of one additional drinking day per month between baseline and the end of the 8-week treatment protocol: CBT4CBT+monitoring cost $33.70 less to produce a reduction of one additional drinking day per month because CBT4CBT+monitoring was less costly than TAU and more effective at treatment termination, though not significantly so. Net benefit analyses suggested that costs of treatment, regardless of condition, did not offset monthly costs related to healthcare utilization, criminal justice involvement, and employment disruption between baseline and 6-month follow-up. Benefit-cost ratios were similar for each condition. CONCLUSIONS Results of this pilot economic evaluation suggest that an 8-week course of CBT4CBT may be a cost-effective addition and potential alternative to standard outpatient treatment for AUD. Additional research is needed to generate conclusions about the cost-benefit of providing CBT4CBT to treatment-seeking individuals participating in standard outpatient treatment.
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Affiliation(s)
- Corinne N. Kacmarek
- American University, Department of Psychology, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062 United States
| | - Brian T. Yates
- American University, Department of Psychology, 4400 Massachusetts Avenue NW, Washington, DC 20016-8062 United States
| | - Charla Nich
- Yale University School of Medicine, Department of Psychiatry, Temple Medical, Building, 40 Temple Street, Suite 6C, Room 618, New Haven, CT 06510 United States
| | - Brian D. Kiluk
- Yale University School of Medicine, Department of Psychiatry, Temple Medical, Building, 40 Temple Street, Suite 6C, Room 618, New Haven, CT 06510 United States
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15
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Moghanibashi-Mansourieh A, Alipour F, Rafiey H, Arshi M. The role of reflective consequences in developing recovery capital for the recovering substance abuser population of Tehran city. J Ethn Subst Abuse 2020; 21:1-13. [PMID: 33236968 DOI: 10.1080/15332640.2020.1845898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study is to explore the hidden dimensions of recovery capital as utilized among a sample of the recovery population of Tehran city. This qualitative study involved a sample of 27 available people, including different groups of recovering drug users and experts. In the semi-structured face-to-face interview, the focus was on the dimensions of recovery capital and contributing factors to recovery. The criteria proposed by Guba and Lincoln were applied for trustworthiness of the research data. After thematic analysis of the data, a total of 310 codes were identified. The theme extracted is the concept of reflective consequences of recovery capital, which has two main categories of passive (altruism, fear of losing existing possessions, fear of repeating past experiences) and persuasion (internal and external). The reflective consequences are the reproducers of recovery capital and can appear at all three individual, micro and mezo levels.
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Affiliation(s)
| | - Fardin Alipour
- Department of Social Work, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hassan Rafiey
- Department of Social Welfare, Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maliheh Arshi
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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16
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Abstract
BACKGROUND Hospitals and other health care delivery organizations are sometimes resistant to implementing evidence-based programs, citing unknown budgetary implications. OBJECTIVE In this paper, I discuss challenges when estimating health care costs in implementation research. DESIGN A case study with intensive care units highlights how including fixed costs can cloud a short-term analysis. PARTICIPANTS None. INTERVENTIONS None. MAIN MEASURES Health care costs, charges and payments. KEY RESULTS Cost data should accurately reflect the opportunity costs for the organization(s) providing care. Opportunity costs are defined as the benefits foregone because the resources were not used in the next best alternative. Because there is no database of opportunity costs, cost studies rely on accounting data, charges, or payments as proxies. Unfortunately, these proxies may not reflect the organization's opportunity costs, especially if the goal is to understand the budgetary impact in the next few years. CONCLUSIONS Implementation researchers should exclude costs that are fixed in the time period of observation because these assets (e.g., space) cannot be used in the next best alternative. In addition, it is common to use costs from accounting databases where we implicitly assume health care providers are uniformly efficient. If providers are not operating efficiently, especially if there is variation in their efficiency, then this can create further problems. Implementation scientists should be judicious in their use of cost estimates from accounting data, otherwise research results can misguide decision makers.
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Affiliation(s)
- Todd H Wagner
- VA Health Economics Resource Center, 795 Willow Rd., 152-MPD, Menlo Park, CA, 94025, USA.
- Stanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford School of Medicine , Stanford, CA, USA.
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17
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Evans EA, Delorme E, Cyr K, Goldstein DM. A qualitative study of big data and the opioid epidemic: recommendations for data governance. BMC Med Ethics 2020; 21:101. [PMID: 33087123 PMCID: PMC7576981 DOI: 10.1186/s12910-020-00544-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The opioid epidemic has enabled rapid and unsurpassed use of big data on people with opioid use disorder to design initiatives to battle the public health crisis, generally without adequate input from impacted communities. Efforts informed by big data are saving lives, yielding significant benefits. Uses of big data may also undermine public trust in government and cause other unintended harms. OBJECTIVES We aimed to identify concerns and recommendations regarding how to use big data on opioid use in ethical ways. METHODS We conducted focus groups and interviews in 2019 with 39 big data stakeholders (gatekeepers, researchers, patient advocates) who had interest in or knowledge of the Public Health Data Warehouse maintained by the Massachusetts Department of Public Health. RESULTS Concerns regarding big data on opioid use are rooted in potential privacy infringements due to linkage of previously distinct data systems, increased profiling and surveillance capabilities, limitless lifespan, and lack of explicit informed consent. Also problematic is the inability of affected groups to control how big data are used, the potential of big data to increase stigmatization and discrimination of those affected despite data anonymization, and uses that ignore or perpetuate biases. Participants support big data processes that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. Recommendations for ethical big data governance offer ways to narrow the big data divide (e.g., prioritize health equity, set off-limits topics/methods, recognize blind spots), enact shared data governance (e.g., establish community advisory boards), cultivate public trust and earn social license for big data uses (e.g., institute safeguards and other stewardship responsibilities, engage the public, communicate the greater good), and refocus ethical approaches. CONCLUSIONS Using big data to address the opioid epidemic poses ethical concerns which, if unaddressed, may undermine its benefits. Findings can inform guidelines on how to conduct ethical big data governance and in ways that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Elizabeth Delorme
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Karl Cyr
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
| | - Daniel M Goldstein
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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18
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Wagner TH, Dopp AR, Gold HT. Estimating Downstream Budget Impacts in Implementation Research. Med Decis Making 2020; 40:968-977. [PMID: 32951506 DOI: 10.1177/0272989x20954387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care decision makers often request information showing how a new treatment or intervention will affect their budget (i.e., a budget impact analysis; BIA). In this article, we present key topics for considering how to measure downstream health care costs, a key component of the BIA, when implementing an evidence-based program designed to reduce a quality gap. Tracking health care utilization can be done with administrative or self-reported data, but estimating costs for these utilization data raises 2 issues that are often overlooked in implementation science. The first issue has to do with applicability: are the cost estimates applicable to the health care system that is implementing the quality improvement program? We often use national cost estimates or average payments, without considering whether these cost estimates are appropriate. Second, we need to determine the decision maker's time horizon to identify the costs that vary in that time horizon. If the BIA takes a short-term time horizon, then we should focus on costs that vary in the short run and exclude costs that are fixed over this time. BIA is an increasingly popular tool for health care decision makers interested in understanding the financial effect of implementing an evidence-based program. Without careful consideration of some key conceptual issues, we run the risk of misleading decision makers when presenting results from implementation studies.
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Affiliation(s)
- Todd H Wagner
- Health Economics Resource Center, US Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Surgery, Stanford University, Stanford, CA
| | | | - Heather T Gold
- Departments of Population Health and Orthopedic Surgery, New York University (NYU) Langone Health, NY, USA
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19
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Kovach JV, Flores MN. Streamlining admissions to outpatient substance use treatment using lean methods. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1821809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jamison V. Kovach
- Project Management Program, University of Houston, Houston, Texas, USA
| | - Manuel N. Flores
- Project Management Program, University of Houston, Houston, Texas, USA
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20
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Yates BT. Research on Improving Outcomes and Reducing Costs of Psychological Interventions: Toward Delivering the Best to the Most for the Least. Annu Rev Clin Psychol 2020; 16:125-150. [PMID: 32040339 DOI: 10.1146/annurev-clinpsy-071519-110415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment and prevention efforts guided by psychological theory, research, and practice can have outcomes of greater value than the resources consumed by those efforts-and outcomes superior to those attainable by other means, often at lower costs. How can we make this hope true more often, for more of the clients who need our services, despite severe resource constraints? Routinely reporting the costs, effectiveness, and benefits of psychological interventions from client, practitioner, and societal perspectives is only a beginning. We also need to use descriptive and inferential statistics to measure, report, and analyze the cost-effectiveness and cost-benefit of our interventions to discover the strongest determinants of intervention costs and outcomes. The emerging literature on cost-inclusive research in psychology suggests that delivery systems are one primary determinant of costs and outcomes of most interventions, as are the psychological techniques applied.
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Affiliation(s)
- Brian T Yates
- Department of Psychology, American University, Washington, DC 20016-8062, USA;
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21
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Moeller SJ, Platt JM, Wu M, Goodwin RD. Perception of treatment need among adults with substance use disorders: Longitudinal data from a representative sample of adults in the United States. Drug Alcohol Depend 2020; 209:107895. [PMID: 32078975 PMCID: PMC7418940 DOI: 10.1016/j.drugalcdep.2020.107895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Most individuals with substance use disorders (SUDs) do not seek treatment. Lack of perceived treatment need (PTN) is one contributing factor, but little is known about PTN over time. We estimated whether PTN changed over three years among those with SUDs in the United States and identified select variables, including sociodemographics and symptom burden, that predict malleability vs. stability of PTN. METHODS Data were from Waves 1 (collected 2001-2002) and 2 (collected 2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); 1695 adults who met DSM criteria for alcohol or non-alcohol SUD at Wave 1 and maintained ≥1 diagnostic symptom at Wave 2 were included. RESULTS Most individuals with SUDs (77.2%) did not perceive a need for treatment at Wave 1 baseline. Only about 1 in 8 individuals not perceiving a need for treatment in Wave 1 came to perceive a need in Wave 2 (adjusted odds ratio = 0.18, 99% confidence interval = 0.11-0.29). In contrast, about half the individuals who perceived a need for treatment in Wave 1 no longer did so in Wave 2, despite maintaining ≥1 SUD symptom. Married respondents, and respondents with more SUD symptoms, were more likely to transition from low- to high-PTN status three years later. Respondents with incomes >$35,000 were less likely to transition to high-PTN status three years later. CONCLUSIONS PTN was more likely to decline than increase over time. Low PTN appears to be stable among adults with SUDs in the United States, presenting a potentially enduring barrier to treatment-seeking.
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Affiliation(s)
- Scott J. Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA
| | - Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA,Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
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22
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Banta-Green C, Williams J, Sears J, Floyd A, Tsui J, Hoeft T. Impact of a jail-based treatment decision-making intervention on post-release initiation of medications for opioid use disorder. Drug Alcohol Depend 2020; 207:107799. [PMID: 31865058 PMCID: PMC8085903 DOI: 10.1016/j.drugalcdep.2019.107799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/29/2019] [Accepted: 11/28/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) is common among people in jail and is effectively treated with medications for OUD (MOUD). People with OUD may have an incomplete or inaccurate understanding of OUD and MOUD, and of how to access care. We evaluated an OUD treatment decision making (TDM) intervention to determine whether the intervention increased MOUD initiation post-release. METHODS We conducted an observational retrospective cohort study of the TDM intervention on initiation of MOUD, individuals with records data indicating confirmed or suspected OUD incarcerated in four eligible jails were eligible to receive the intervention. Time-to-event analyses of the TDM intervention were conducted using Cox proportional hazard modeling with MOUD as the outcome. RESULTS Cox proportional hazard modeling, with the intervention modeled as having a time-varying effect due to violation of the proportionality assumption, indicated that those receiving the TDM intervention (n = 568) were significantly more likely to initiate MOUD during the first month after release from jail (adjusted hazard ratio 6.27, 95 % C.I. 4.20-9.37), but not in subsequent months (AHR 1.33 95 % C.I. 0.94-1.89), adjusting for demographics, prior MOUD, or felony or gross misdemeanor arrest in the prior year compared to those not receiving the intervention (n = 3174). CONCLUSION The TDM intervention was associated with a significantly higher relative hazard of starting MOUD, specifically during the first month after incarceration. However, a minority of all eligible people received any MOUD. Future research should examine ways to increase initiation on MOUD immediately after (or ideally during) incarceration.
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Affiliation(s)
- C.J. Banta-Green
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA,Corresponding author. (C.J. Banta-Green)
| | - J.R. Williams
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - J.M. Sears
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA,Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA,Harborview Injury Prevention and Research Center, Seattle, WA, USA,Institute for Work and Health, Toronto, Ontario, Canada
| | - A.S. Floyd
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - J.I. Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - T.J. Hoeft
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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23
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Gass M, Wilson T, Talbot B, Tucker A, Ugianskis M, Brennan N. The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions. Subst Abuse 2019; 13:1178221819870768. [PMID: 31456639 PMCID: PMC6702774 DOI: 10.1177/1178221819870768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 12/04/2022]
Abstract
The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were $27 426 for OBH and $31 113 for TAU. OBH also had a cost-benefit ratio of 60.4% higher than TAU, an increased Quality in Life Years (QALY) life span, societal benefits of an additional $36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument.
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24
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Rouse WB, Johns MM, Pepe KM. Service supply chains for population health: Overcoming fragmentation of service delivery ecosystems. Learn Health Syst 2019; 3:e10186. [PMID: 31245604 PMCID: PMC6508805 DOI: 10.1002/lrh2.10186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Population health involves integration of health, education, and social services to keep a defined population healthy, to address health challenges holistically, and to assist with the realities of being mortal. The fragmentation of the US population health delivery system is addressed. The impacts of this fragmentation on the treatment of substance abuse in the United States are considered. Innovations needed to overcome this fragmentation are proposed. APPROACH Treatment capacity issues, including scheduling practices, are discussed. Costs of treatment and lack of treatment are considered. Models of integrated care delivery are reviewed. Potential innovations from systems science, behavioral economics, and social networks are considered. The implications of these innovations are discussed in terms of information technology (IT) systems and governance. CONCLUSIONS Enormous savings are possible with more integrated treatment. Based on a range of empirical findings, it is argued that investments of these resources in integrated delivery of care have the potential to dramatically improve health outcomes, thereby significantly reducing the costs of population health.
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Affiliation(s)
- William B. Rouse
- Center for Complex Systems & EnterprisesStevens Institute of TechnologyHobokenNew Jersey
| | | | - Kara M. Pepe
- Center for Complex Systems & EnterprisesStevens Institute of TechnologyHobokenNew Jersey
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25
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Tsai J, Gu X. Utilization of addiction treatment among U.S. adults with history of incarceration and substance use disorders. Addict Sci Clin Pract 2019; 14:9. [PMID: 30836991 PMCID: PMC6402155 DOI: 10.1186/s13722-019-0138-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background The high prevalence of substance use disorders (SUDs) among incarcerated adults in the U.S. is well-known, but there has been less examination of SUD treatment and rates of incarceration among the population of adults with SUDs as the denominator. The current study uses a population-based sample to address three questions: (1) What is the rate of lifetime incarceration among the population of U.S. adults with SUDs?; (2) Among adults with SUDs, what proportion of those with incarceration histories use SUD treatment compared to those without incarceration histories?; and (3) What individual characteristics are associated with utilization of SUD treatment among adults with incarceration histories? Methods Data were based on the National Epidemiologic Survey on Alcohol and Related Conditions-III which surveyed a nationally representative sample of U.S. adults through structured interviews. This study focused on the 10,853 respondents who had any lifetime SUD, including 2670 (weighted 22.4%) who reported a lifetime history of incarceration. Results In the total weighted sample of respondents with SUDs, 22% had been incarcerated before but only 37% had used any alcohol use disorder treatment and 18% had used drug use disorder treatment. Controlling for confounding variables, respondents with SUDs and incarceration histories had 3.1 times the odds of using alcohol use disorder treatment and 1.6 times the odds of using drug use disorder treatment compared to their counterparts with SUDs and no incarceration histories. Having an opioid use disorder, especially heroin use disorder, and a stimulant use disorder, such as cocaine use disorder, had strong associations with any SUD treatment use. Conclusions Many U.S. adults with SUDs have histories of incarceration but only a minority use any SUD treatment. Public health approaches that increase access and incentives to engage in and complete SUD treatment may help resolve problems of both incarceration and SUDs in the population.
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Affiliation(s)
- Jack Tsai
- Department of Veterans Affairs (VA), New England Mental Illness Research, Education, and Clinical Center (MIRECC), 950 Campbell Ave., 151D, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George St., New Haven, CT, 06511, USA.
| | - Xian Gu
- Department of Biostatistics, Yale School of Public Health, 60 College St., New Haven, CT, 06520, USA
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26
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Symons M, Feeney GFX, Gallagher MR, Young RM, Connor JP. Machine learning vs addiction therapists: A pilot study predicting alcohol dependence treatment outcome from patient data in behavior therapy with adjunctive medication. J Subst Abuse Treat 2019; 99:156-162. [PMID: 30797388 DOI: 10.1016/j.jsat.2019.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinical staff providing addiction treatment predict patient outcome poorly. Prognoses based on linear statistics are rarely replicated. Addiction is a complex non-linear behavior. Incorporating non-linear models, Machine Learning (ML) has successfully predicted treatment outcome when applied in other areas of medicine. Using identical assessment data across the two groups, this study compares the accuracy of ML models versus clinical staff to predict alcohol dependence treatment outcome in behavior therapy using patient data only. METHODS Machine learning models (n = 28) were constructed ('trained') using demographic and psychometric assessment data from 780 previously treated patients who had undertaken a 12 week, abstinence-based Cognitive Behavioral Therapy program for alcohol dependence. Independent predictions applying assessment data for an additional 50 consecutive patients were obtained from 10 experienced addiction therapists and the 28 trained ML models. The predictive accuracy of the ML models and the addiction therapists was then compared with further investigation of the 10 best models selected by cross-validated accuracy on the training-set. Variables selected as important for prediction by staff and the most accurate ML model were examined. RESULTS The most accurate ML model (Fuzzy Unordered Rule Induction Algorithm, 74%) was significantly more accurate than the four least accurate clinical staff (51%-40%). However, the robustness of this finding may be limited by the moderate area under the receiver operator curve (AUC = 0.49). There was no significant difference in mean aggregate predictive accuracy between 10 clinical staff (56.1%) and the 28 best models (58.57%). Addiction therapists favoured demographic and consumption variables compared with the ML model using more questionnaire subscales. CONCLUSIONS The majority of staff and ML models were not more accurate than suggested by chance. However, the best performing prediction models may provide useful adjunctive information to standard clinically available prognostic data to more effectively target treatment approaches in clinical settings.
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Affiliation(s)
- Martyn Symons
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Wooloongabba, Brisbane, Queensland 4102, Australia; Discipline of Psychiatry, The University of Queensland, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia; Telethon Kids Institute, West Perth, Western Australia 6872, Australia
| | - Gerald F X Feeney
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Wooloongabba, Brisbane, Queensland 4102, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Upland Road, St Lucia, Brisbane, Queensland 4072, Australia
| | - Marcus R Gallagher
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Ross McD Young
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Wooloongabba, Brisbane, Queensland 4102, Australia; Faculty of Health, Queensland University of Technology, Kelvin Grove, Brisbane, Queensland 4059, Australia
| | - Jason P Connor
- Alcohol and Drug Assessment Unit, Princess Alexandra Hospital, Wooloongabba, Brisbane, Queensland 4102, Australia; Discipline of Psychiatry, The University of Queensland, K Floor, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia; Centre for Youth Substance Abuse Research, The University of Queensland, Upland Road, St Lucia, Brisbane, Queensland 4072, Australia.
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27
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Lyons T, Womack VY, Cantrell WD, Kenemore T. Mindfulness-Based Relapse Prevention in a Jail Drug Treatment Program. Subst Use Misuse 2019; 54:57-64. [PMID: 30409061 PMCID: PMC6473813 DOI: 10.1080/10826084.2018.1491054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND More than half of prisoners in the United States are estimated to suffer from a substance use disorder. Mindfulness involves attention to the present moment, and nonjudgmental acceptance of sensations, thoughts, and emotional states. Mindfulness-based relapse prevention (MBRP) following substance use disorder treatment has been shown to reduce substance use. OBJECTIVE We sought to adapt and test MBRP for a jail substance use disorder treatment setting. METHODS We enrolled successive cohorts of incarcerated men participating in a drug treatment program in a large urban jail (n = 189) into six weekly sessions of either MBRP or an comparison communication skills intervention, between 2013 and 2015. MBRP was delivered by a culturally competent African-American trainer. Pre- and post-test measures included mindfulness, anxiety, posttraumatic stress disorder (PTSD), and drug craving. RESULTS At baseline, measures of mindfulness were significantly inversely correlated with anxiety, PTSD symptoms and drug cravings. Anxiety, PTSD symptoms and cravings declined significantly in both treatment arms, and mindfulness increased. Comparison of the two study arms using maximum likelihood estimation suggested a small but significantly greater increase in mindfulness in the treatment arm. Conclusions/Importance. An attention control trial of a mindfulness intervention, delivered by a culturally competent trainer, is feasible in a jail setting.
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Affiliation(s)
- Thomas Lyons
- a Illinois Circuit Court of Cook County , Chicago , Illinois , USA
| | - Veronica Y Womack
- b Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Abstract
The US is facing dual public health crises related to opioid overdose deaths and HIV. Injection drug use is fueling both of these epidemics. The War on Drugs has failed to stem injection drug use and has contributed to mass incarceration, poverty, and racial disparities. Harm reduction is an alternative approach that seeks to decrease direct and indirect harms associated with drug use without necessarily decreasing drug consumption. Although overwhelming evidence demonstrates that harm reduction is effective in mitigating harms associated with drug use and is cost-effective in providing these benefits, harm reduction remains controversial and the ethical implications of harm reduction modalities have not been well explored. This paper analyzes harm reduction for injection drug use using the core principles of autonomy, nonmaleficence, beneficence, and justice from both clinical ethics and public health ethics perspectives. This framework is applied to harm reduction modalities currently in use in the US, including opioid maintenance therapy, needle and syringe exchange programs, and opioid overdose education and naloxone distribution. Harm reduction interventions employed outside of the US, including safer injection facilities, heroin-assisted treatment, and decriminalization/legalization are then discussed. This analysis concludes that harm reduction is ethically sound and should be an integral aspect of our nation's healthcare system for combating the opioid crisis. From a clinical ethics perspective, harm reduction promotes the autonomy of, prevents harms to, advances the well-being of, and upholds justice for persons who use drugs. From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.
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Wagner TH, Almenoff P, Francis J, Jacobs J, Pal Chee C. Assessment of the Medicare Advantage Risk Adjustment Model for Measuring Veterans Affairs Hospital Performance. JAMA Netw Open 2018; 1:e185993. [PMID: 30646300 PMCID: PMC6324352 DOI: 10.1001/jamanetworkopen.2018.5993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Policymakers and consumers are eager to compare hospitals on performance metrics, such as surgical complications or unplanned readmissions, measured from administrative data. Fair comparisons depend on risk adjustment algorithms that control for differences in case mix. OBJECTIVE To examine whether the Medicare Advantage risk adjustment system version 21 (V21) adequately risk adjusts performance metrics for Veterans Affairs (VA) hospitals. DESIGN, SETTING, AND PARTICIPANTS This cohort analysis of administrative data from all 5.5 million veterans who received VA care or VA-purchased care in 2012 was performed from September 8, 2015, to October 22, 2018. Data analysis was performed from January 22, 2016, to October 22, 2018. EXPOSURES A patient's risk as measured by the V21 model. MAIN OUTCOMES AND MEASURES The main outcome was total cost, and the key independent variable was the V21 risk score. RESULTS Of the 5 472 629 VA patients (mean [SD] age, 63.0 [16.1] years; 5 118 908 [93.5%] male), the V21 model identified 694 706 as having a mental health or substance use condition. In contrast, a separate classification system for psychiatric comorbidities identified another 1 266 938 patients with a mental health condition. The V21 model missed depression not otherwise specified (396 062 [31.3%]), posttraumatic stress disorder (345 338 [27.3%]), and anxiety (129 808 [10.2%]). Overall, the V21 model underestimated the cost of care by $2314 (6.7%) for every person with a mental health diagnosis. CONCLUSIONS AND RELEVANCE The findings suggest that current aspirations to engender competition by comparing hospital systems may not be appropriate or fair for safety-net hospitals, including the VA hospitals, which treat patients with complex psychiatric illness. Without better risk scores, which is technically possible, outcome comparisons may potentially mislead consumers and policymakers and possibly aggravate inequities in access for such vulnerable populations.
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Affiliation(s)
- Todd H. Wagner
- Stanford University School of Medicine, Palo Alto, California
- Center for Innovation to Implementation, VA Palo Alto, Menlo Park, California
- Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Peter Almenoff
- Office of Secretary, Department of Veterans Affairs, Washington, DC
- Center of Innovation, Department of Veterans Affairs, Washington, DC
- Program for Quality Improvement/Patient Safety, School of Medicine, University of Missouri–Kansas City, Kansas City
- Office of Reporting, Analytics, Performance, Improvement, and Deployment, Department of Veterans Affairs, Washington, DC
| | - Joseph Francis
- Office of Reporting, Analytics, Performance, Improvement, and Deployment, Department of Veterans Affairs, Washington, DC
| | - Josephine Jacobs
- Center for Innovation to Implementation, VA Palo Alto, Menlo Park, California
- Health Economics Resource Center, VA Palo Alto, Menlo Park, California
| | - Christine Pal Chee
- Health Economics Resource Center, VA Palo Alto, Menlo Park, California
- Department of Public Policy, Stanford University, Palo Alto, California
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Khazaee-Pool M, Moeeni M, Ponnet K, Fallahi A, Jahangiri L, Pashaei T. Perceived barriers to methadone maintenance treatment among Iranian opioid users. Int J Equity Health 2018; 17:75. [PMID: 29890990 PMCID: PMC5996552 DOI: 10.1186/s12939-018-0787-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background Opioid use is a severe problem in Iran. Despite methadone maintenance treatment (MMT) programs being one of the most important treatment strategies for reducing individual and public harms associated with opioid use, a large proportion of Iranian patients refuse to participate in such treatment programs. Methods The present study aims to explore the beliefs and attitudes toward MMT programs of opioid-dependent patients who were participating or had participated in methadone therapy. In-depth interviews were conducted with 23 opioid users between 27 and 58 years of age from Kurdistan provinces. Results Overall, six themes were discovered to be key barriers relating to methadone treatment, including financial barriers related to methadone treatment, lack of awareness about methadone treatment, negative attitudes regarding using methadone, worries about methadone’s side effects, social stigma ascribed to methadone therapy, and systemic barriers to methadone treatment. Conclusion Our study revealed that the cost of treatment is a major obstacle to attending and continuing at MMT programs and that addicts and their families are not always accurately informed about the duration of MMT programs and the side effects of methadone treatment.
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Affiliation(s)
- Maryam Khazaee-Pool
- Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Moeeni
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Koen Ponnet
- Department of Communication Sciences, imec-mict-Ghent University, Ghent, Belgium
| | - Arezoo Fallahi
- Enviromental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Science, Sanandaj, Iran
| | - Leila Jahangiri
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tahereh Pashaei
- Enviromental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Science, Sanandaj, Iran. .,Department of Public Health, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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Burgos JL, Cepeda JA, Kahn JG, Mittal ML, Meza E, Lazos RRP, Vargas PC, Vickerman P, Strathdee SA, Martin NK. Cost of provision of opioid substitution therapy provision in Tijuana, Mexico. Harm Reduct J 2018; 15:28. [PMID: 29792191 PMCID: PMC5967039 DOI: 10.1186/s12954-018-0234-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. METHODS We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. RESULTS The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose. CONCLUSIONS The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.
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Affiliation(s)
- Jose Luis Burgos
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Javier A Cepeda
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.
| | - James G Kahn
- Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, USA
| | - Maria Luisa Mittal
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | | | | | | | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Steffanie A Strathdee
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, Department of Medicine, University of California, San Diego, USA.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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Isobell D, Kamaloodien K, Savahl S. Addiction treatment providers’ perceptions of publicly-funded treatment services in the Western Cape, South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2017.1419919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Deborah Isobell
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Kamal Kamaloodien
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Shazly Savahl
- Department of Psychology, University of the Western Cape, Cape Town, South Africa
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Maclean JC, Saloner B. Substance Use Treatment Provider Behavior and Healthcare Reform: Evidence from Massachusetts. HEALTH ECONOMICS 2018; 27:76-101. [PMID: 28224675 DOI: 10.1002/hec.3484] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/31/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
We examine the impact of the 2006 Massachusetts healthcare reform on substance use disorder (SUD) treatment facilities' provision of care. We test the impact of the reform on treatment quantity and access. We couple data on the near universe of specialty SUD treatment providers in the USA with a synthetic control method approach. We find little evidence that the reform lead to changes in treatment quantity or access. Reform effects were similar among for-profit and non-profit facilities. In an extension, we show that the reform altered the setting in which treatment is received, the number of offered services, and the number of programs for special populations. These findings may be useful in predicting the implications of major health insurance expansions on the provision of SUD treatment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Economics, Temple University, Philadelphia, PA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
- Institute of Labor Economics (IZA), Bonn, North Rhine-Westphalia, Germany
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Moore J, Goodman P, Selway J, Hawkins-Walsh E, Merritt J, Dombrowski J. SBIRT Education for Nurse Practitioner Students: Integration Into an MSN Program. J Nurs Educ 2017; 56:725-732. [DOI: 10.3928/01484834-20171120-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/22/2017] [Indexed: 11/20/2022]
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McCollister K, Yang X, Sayed B, French MT, Leff JA, Schackman BR. Monetary conversion factors for economic evaluations of substance use disorders. J Subst Abuse Treat 2017; 81:25-34. [PMID: 28847452 DOI: 10.1016/j.jsat.2017.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/23/2017] [Accepted: 07/15/2017] [Indexed: 01/12/2023]
Abstract
AIMS Estimating the economic consequences of substance use disorders (SUDs) is important for evaluating existing programs and new interventions. Policy makers in particular must weigh program effectiveness with scalability and sustainability considerations in deciding which programs to fund with limited resources. This study provides a comprehensive list of monetary conversion factors for a broad range of consequences, services, and outcomes, which can be used in economic evaluations of SUD interventions (primarily in the United States), including common co-occurring conditions such as HCV and HIV. METHODS Economic measures were selected from standardized clinical assessment instruments that are used in randomized clinical trials and other research studies (e.g., quasi-experimental community-based projects) to evaluate the impact of SUD interventions. National datasets were also reviewed for additional SUD-related consequences, services, and outcomes. Monetary conversion factors were identified through a comprehensive literature review of published articles as well as targeted searches of other sources such as government reports. RESULTS Eight service/consequence/outcome domains were identified containing more than sixty monetizable measures of medical and behavioral health services, laboratory services, SUD treatment, social services, productivity outcomes, disability outcomes, criminal activity and criminal justice services, and infectious diseases consequences. Unit-specific monetary conversion factors are reported, along with upper and lower bound estimates, whenever possible. CONCLUSIONS Having an updated and standardized source of monetary conversion factors will facilitate and improve future economic evaluations of interventions targeting SUDs and other risky behaviors. This exercise should be repeated periodically as new sources of data become available to maintain the timeliness, comprehensiveness, and quality of these estimates.
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Affiliation(s)
- Kathryn McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Soffer Clinical Research Center, Suite 1019, 1120 NW 14th Street, Miami, FL 33136, USA.
| | - Xuan Yang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Soffer Clinical Research Center, Suite 1019, 1120 NW 14th Street, Miami, FL 33136, USA.
| | - Bisma Sayed
- Department of Sociology and Health Economics Research Group, University of Miami, 5665 Ponce de Leon Boulevard, Flipse Building, Room 122, P.O. Box 248251, Coral Gables, FL 33124, USA.
| | - Michael T French
- Department of Health Sector Management and Policy, Department of Sociology, University of Miami, School of Business Administration, P.O. Box 248027, Coral Gables, FL 33124, USA.
| | - Jared A Leff
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, Suite 301, New York, NY 10065, USA.
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medical College, 425 E 61st Street, Suite 301, New York, NY 10065, USA.
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Krebs E, Min JE, Evans E, Li L, Liu L, Huang D, Urada D, Kerr T, Hser YI, Nosyk B. Estimating State Transitions for Opioid Use Disorders. Med Decis Making 2017; 37:483-497. [PMID: 28027027 PMCID: PMC5536954 DOI: 10.1177/0272989x16683928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM The aim was to estimate transitions between periods in and out of treatment, incarceration, and legal supervision, for prescription opioid (PO) and heroin users. METHODS We captured all individuals admitted for the first time for publicly funded treatment for opioid use disorder (OUD) in California (2006 to 2010) with linked mortality and criminal justice data. We used Cox proportional hazards and competing risks models to assess the effect of primary PO use (v. heroin) on the hazard of transitioning among 5 states: (1) opioid detoxification treatment; (2) opioid agonist treatment (OAT); (3) legal supervision (probation or parole); (4) incarceration (jail or prison); and (5) out-of-treatment. Transitions were conditional on survival, and death was modeled as an absorbing state. RESULTS Both primary PO (n = 11,733) and heroin (n = 19,926) users spent most of their median 2.3 y of observation out of treatment. Primary PO users were significantly younger (median age 30 v. 34 y), and a higher percentage were female (43.1% v. 31.5%; P < 0.001), white (74.6% v. 63.1%; P < 0.001), and had completed high school (31.8% v. 18.9%; P < 0.001). When compared to primary heroin users, PO users had a higher hazard of transitioning from detoxification to OAT (Hazard Ratio (HR), 1.65; 95% CI, 1.54 to 1.77), and had a lower hazard of transitioning from out-of-treatment to either detoxification (0.75 [0.70, 0.81]) or OAT (0.90 [0.85, 0.96]). CONCLUSION Our findings can be applied directly in state transition modeling to improve the validity of health economic evaluations. Although PO users tended to remain in treatment for longer durations than heroin users, they also tended to remain out of treatment for longer after transitioning to an out-of-treatment state. Despite the proven effectiveness of time-unlimited treatment, individuals with OUD spend most of their time out of treatment.
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Affiliation(s)
| | - Jeong E. Min
- British Columbia Centre for Excellence in HIV/AIDS
| | | | - Libo Li
- UCLA Integrated Substance Abuse Programs
| | - Lei Liu
- Northwestern University Feinberg School of Medicine
| | | | | | - Thomas Kerr
- UCLA Integrated Substance Abuse Programs
- Division of AIDS, Faculty of Medicine, University of British Columbia
| | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,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, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - 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, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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O'Donnell FT, Jackson DL. Opioid Use Disorder and Pregnancy. MISSOURI MEDICINE 2017; 114:181-186. [PMID: 30228577 PMCID: PMC6140233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Over-prescription of opioid pain medications and increases in heroin use have contributed to the sharp rise in opioid-related hospitalizations and overdose deaths among young adults in the United States, including pregnant women. This has imposed substantial direct and indirect costs to our nation's health care system. Effective treatment with methadone and buprenorphine is available, but significant barriers to care may restrict access for many. Improved screening tools and expanded access to treatments for substance use disorders are keys to addressing the epidemic of opioid use disorder.
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Affiliation(s)
- Frederick T O'Donnell
- Frederick T. O'Donnell, MD, Assistant Professor of clinical Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Missouri Women's and Children's Hospital, Columbia, Missouri
| | - Daniel L Jackson
- Daniel L. Jackson, MD, Assistant Professor of Clinical Obstetrics and Gynecology, Department of Obstetrics, Gynecology and Women's Health, University of Missouri Women's and Children's Hospital, Columbia, Missouri
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Mahendraratnam N, Dusetzina SB, Farley JF. Prescription Drug Utilization and Reimbursement Increased Following State Medicaid Expansion in 2014. J Manag Care Spec Pharm 2017; 23:355-363. [PMID: 28230452 PMCID: PMC10398028 DOI: 10.18553/jmcp.2017.23.3.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) expanded health care and medication insurance coverage through Medicaid expansion in select states. Expansion has the potential to increase the availability of health services to patients, including prescription medications. However, limited studies have examined how expansion affected prescription drug utilization and reimbursement. OBJECTIVE To compare prescription drug utilization (number of prescriptions filled) and reimbursement trends between states that did and did not expand Medicaid coverage in 2014, while accounting for known effects of expansion on Medicaid enrollment. METHODS We conducted a comparative interrupted time series using retrospective Medicaid state drug utilization data from 2011 to 2014. After inclusion/exclusion criteria, 8 states that expanded Medicaid in 2014 and 10 states that did not expand Medicaid were studied. Primary outcomes were changes in quarterly prescription drug utilization and quarterly total prescription drug reimbursement before and after expansion. To account for increases in enrollment in expansion states, secondary outcomes were per-member-per-quarter (PMPQ) utilization and reimbursement before and after expansion. RESULTS Expansion states experienced a 1.4 million prescriptions per quarter and $163 million per quarter increase in utilization and reimbursement above the change in rates observed in nonexpansion states after expansion (P < 0.001). Specifically, 1 year after ACA implementation, expansion states used 17.0% more prescriptions and spent 36.1% more in reimbursement than the quarter preceding expansion. Expansion and nonexpansion states experienced significant drops in PMPQ prescriptions immediately after expansion (P < 0.001), but PMPQ prescriptions and reimbursement trends increased by the end of the postexpansion period in expansion states (P < 0.029 and P < 0.001, respectively). CONCLUSIONS Study results suggest that Medicaid expansion offers vulnerable patients who were previously uninsured increased access to health care resources, specifically prescription drugs. Although this hypothesis would benefit from further testing, it aligns with previous studies that have shown that Medicaid expansion has led to increased access to coverage and care. While enrollment contributes to the increase in prescription utilization and reimbursement, the drop in PMPQ utilization suggests that the patients entering the program are healthier than existing patients. This shows that risk pooling is working. However, the increase in PMPQ reimbursement suggests that new enrollment may not be the only factor driving reimbursement changes. Factors such as changes in product mix, risk pool composition, and drug pricing and their effects on total and per-member reimbursement should be evaluated in future studies. DISCLOSURES No outside funding supported this study. Mahendraratnam is currently a Worldwide Health Economics and Outcomes Research Pre-doctoral Fellow at Bristol-Myers Squibb and previously provided advisory services to public and private sector clients while employed at Avalere Health, an Inovalon Company, as well as completed an internship at Genentech, a member of the Roche Group. Farley and Dusetzina have no conflicts of interest to report. Preliminary results of this study were presented at the 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st Annual Meeting in Washington, DC, on May 21-25, 2016, and the 2016 AcademyHealth Annual Research Meeting (ARM) in Boston, Massachusetts, on June 26-28, 2016. Study concept and design were contributed by Farley, Mahendraratnam, and Dusetzina. Mahendraratnam, Farley, and Dusetzina collected the data, and data interpretation was performed by all the authors. The manuscript was written by Mahendraratnam, Farley, and Dusetzina and revised by Farley, Dusetzina, and Mahendraratnam.
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Roche A, Nicholas R. Workforce development: An important paradigm shift for the alcohol and other drugs sector. DRUGS-EDUCATION PREVENTION AND POLICY 2016. [DOI: 10.1080/09687637.2016.1262823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ann Roche
- National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia
| | - Roger Nicholas
- National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia
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Robinson SM. “Alcoholic” or “Person with alcohol use disorder”? Applying person-first diagnostic terminology in the clinical domain. Subst Abus 2016; 38:9-14. [DOI: 10.1080/08897077.2016.1268239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sean M. Robinson
- Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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43
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Ritter A, Stoove M. Alcohol and other drug treatment policy in Australia. Med J Aust 2016; 204:138. [PMID: 26937658 DOI: 10.5694/mja15.01372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Alison Ritter
- National Drug and Alcohol Research Centre, Sydney, NSW
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Morse DS, Silverstein J, Thomas K, Bedel P, Cerulli C. Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants. HEALTH & JUSTICE 2015; 3:12. [PMID: 26478853 PMCID: PMC4607061 DOI: 10.1186/s40352-015-0026-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Therapeutic diversion courts seek to address justice-involved participants' underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives. METHODS Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health. RESULTS Numerous systemic factors impacted women's access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options. CONCLUSIONS By understanding the social determinant of health for women in drug treatment court and stakeholder's perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.
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Affiliation(s)
- Diane S. Morse
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
- University of Rochester School of Medicine, Women’s Initiative Supporting Health Center for Community Health, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Jennifer Silverstein
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Katherine Thomas
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Precious Bedel
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
| | - Catherine Cerulli
- University of Rochester School of Medicine, Department of Psychiatry, 300 Crittenden Blvd., Rochester, NY 14642 USA
- University of Rochester School of Medicine, LIVV and Susan B. Anthony Center for Women’s Leadership, 300 Crittenden Blvd., Rochester, NY 14642 USA
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Galbraith N. The methamphetamine problem: Commentary on … Psychiatric morbidity and socio-occupational dysfunction in residents of a drug rehabilitation centre. BJPsych Bull 2015; 39:218-20. [PMID: 26755964 PMCID: PMC4706185 DOI: 10.1192/pb.bp.115.050930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This paper introduces the reader to the characteristics of methamphetamine. Explored within are the drug's effects on those who consume it as well as the history and prevalence of its use. The highly addictive nature of methamphetamine is compounded by its affordability and the ease with which it is produced, with North America and East Asia having become established as heartlands for both consumption and manufacture. The paper discusses recent cultural depictions of the drug and also the role that mental health professionals may take in designing and delivering interventions to treat methamphetamine addiction.
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Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015; 110:1404-15. [PMID: 25913697 PMCID: PMC4753046 DOI: 10.1111/add.12950] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. METHODS A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups. RESULTS Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92-1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81-1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. CONCLUSIONS There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.
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Affiliation(s)
- Joseph E. Glass
- School of Social Work, University of Wisconsin-Madison, Madison, WI
| | | | - Byron J. Powell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian E. Perron
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Randall T. Brown
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Mark A. Ilgen
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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Meyer R, Patel AM, Rattana SK, Quock TP, Mody SH. Prescription opioid abuse: a literature review of the clinical and economic burden in the United States. Popul Health Manag 2015; 17:372-87. [PMID: 25075734 DOI: 10.1089/pop.2013.0098] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole.
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Colón Jordán HM, Laborde Rivera JE, Marín Centeno HA, Albizu-García CE. Medical Costs of Persons with Drug Use Disorders Among Medicaid Managed Care Beneficiaries in Puerto Rico : Comparison of the Direct Services Costs Incurred by Beneficiaries With and Without a Drug Use Disorder. J Behav Health Serv Res 2015. [PMID: 26219253 DOI: 10.1007/s11414-015-9469-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Drug use disorders (DUDs) can substantially increase the costs of health care, especially when left untreated. Yet, not much is known about the specific types of medical services that give rise to these cost differences. This study aimed to estimate the medical costs of beneficiaries with DUDs enrolled in the Medicaid Managed Care (MMC) program in Puerto Rico using claims data. These were compared to those of a matched group of patients without DUDs. On average, each beneficiary with a DUD incurred in $4539 annually on medical services compared to $2601 in the matched comparison group, a cost differential of $1938. Close to half of these additional medical costs (43.4%) were generated in the physical health services sector. Counts of service claims were also higher for beneficiaries with DUDs than for beneficiaries without DUDs in all service types, except in outpatient and laboratory services for physical health. A host of access strategies and treatment modalities should be tested to assess the extent to which providing adequate access and adequate treatment for a DUD can contribute to cost savings.
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Affiliation(s)
- Héctor M Colón Jordán
- Health Systems Evaluation and Research Program and The Center for Sociomedical and Evaluation Research, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - José E Laborde Rivera
- Department of Economics, School of Social Sciences, Río Piedras Campus, University of Puerto Rico, San Juan, Puerto Rico.
| | - Heriberto A Marín Centeno
- Health Administration Department, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Carmen E Albizu-García
- Health Systems Evaluation and Research Program and The Center for Sociomedical and Evaluation Research, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Meyer JP, Cepeda J, Taxman FS, Altice FL. Sex-Related Disparities in Criminal Justice and HIV Treatment Outcomes: A Retrospective Cohort Study of HIV-Infected Inmates. Am J Public Health 2015; 105:1901-10. [PMID: 26180958 DOI: 10.2105/ajph.2015.302687] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We evaluated sex-related differences in HIV and criminal justice (CJ) outcomes. METHODS We quantified sex-related differences in criminal offenses, incarcerations, and HIV outcomes among all HIV-infected inmates on antiretroviral therapy (ART) in Connecticut (2005-2012). Computed criminogenic risk scores estimated future CJ involvement. Stacked logistic regression models with random effects identified significant correlates of HIV viral suppression on CJ entry, reflecting preceding community-based treatment. RESULTS Compared with 866 HIV-infected men on ART (1619 incarcerations), 223 women (461 incarcerations) were more likely to be younger, White, and medically insured, with shorter incarceration periods (mean = 196.8 vs 368.1 days), mostly for public disorder offenses. One third of both women and men had viral suppression on CJ entry, correlating positively with older age and having treated comorbidities. Entry viral suppression inversely correlated with incarceration duration for women and with criminogenic risk score for men. CONCLUSIONS In the largest contemporary cohort of HIV-infected inmates on ART, women's higher prevalence of nonviolent offenses and treatable comorbidities supports alternatives to incarceration strategies. Sex-specific interventions for CJ populations with HIV effectively align public health and safety goals.
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Affiliation(s)
- Jaimie P Meyer
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Javier Cepeda
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Faye S Taxman
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
| | - Frederick L Altice
- Jaimie P. Meyer and Frederick L. Altice are with the AIDS Program, Yale School of Medicine, New Haven, CT. Jaimie P. Meyer is also with the Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven. Javier Cepeda and Frederick L. Altice are with the Department of Epidemiology of Microbial Diseases, Yale School of Public Health. Faye S. Taxman is with the Criminology, Law, and Society Department, George Mason University, Fairfax, VA
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Pestka E, Nash V, Evans M, Cronin J, Bee S, King S, Osborn K, Gehin J, Weis K, Loukianova L. Assessment of family history of substance abuse for preventive interventions with patients experiencing chronic pain: A quality improvement project. Int J Nurs Pract 2015; 22:121-8. [DOI: 10.1111/ijn.12400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Virginia Nash
- Department of Psychiatry; Mayo Clinic; Rochester Minnesota USA
| | - Michele Evans
- Department of Psychiatry; Mayo Clinic; Rochester Minnesota USA
| | - Joan Cronin
- Department of Anesthesiology; Mayo Clinic; Rochester Minnesota USA
| | - Susan Bee
- Department of Psychiatry; Mayo Clinic; Rochester Minnesota USA
| | - Susan King
- Department of Nursing; Mayo Clinic; Rochester Minnesota USA
| | | | - Jessica Gehin
- Department of Nursing; Mayo Clinic; Jacksonville Florida USA
| | - Karen Weis
- Department of Psychiatry; Mayo Clinic; Rochester Minnesota USA
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