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Racial and ethnic disparities associated with the measure for drug-drug interactions among Medicare beneficiaries. J Am Pharm Assoc (2003) 2022; 62:142-149. [PMID: 34509379 PMCID: PMC8742744 DOI: 10.1016/j.japh.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/28/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Drug-drug interactions (DDIs) cause many preventable hospitalizations and admissions. Efforts have been made to raise DDI awareness and reduce DDI occurrence; for example, Medicare Part D Star Ratings, a health plan quality assessment program, included a DDI measure. Previous research reported racial and ethnic disparities in health services utilization and that racial and ethnic minorities, compared with non-Hispanic whites (whites), may be less likely to be targeted for a similar measure, a Star Ratings adherence measure for diabetes medications. OBJECTIVE This study aimed to investigate whether any racial and ethnic disparities are associated with the DDI measure in Part D Star Ratings among Medicare populations with diabetes, hypertension, and hyperlipidemia. METHODS This cross-sectional study analyzed a 2017 Medicare Part D data sample, including 3,960,813 beneficiaries. Because the inclusion in the denominator of the Star Ratings DDI measure was determined by the use of a list of target medications, the likelihood of using a listed target medication was compared between racial and ethnic minorities and whites. Individuals with diabetes, hypertension, and hyperlipidemia were included in the analysis owing to the high prevalence of these conditions. Patient- and community-level characteristics were adjusted by logistic regression. RESULTS Of the entire study sample, 26.2% used a target medication. Compared with whites, most racial and ethnic minorities were less likely to use a target medication. For example, among individuals with diabetes, blacks, Hispanics, Asians/Pacific Islanders, and others had, respectively, 14% (odds ratio 0.86 [95% CI 0.84-0.88]), 5% (0.95 [0.93-0.98]), 12% (0.88 [0.84-0.92]), and 10% (0.90 [0.87-0.93]) lower odds compared with whites. Findings were similar among hypertension and hyperlipidemia cohorts, except that Hispanics had similar odds of use as whites. CONCLUSION Most racial and ethnic minorities may have lower likelihood of being targeted for the DDI measure compared with whites. Future studies should examine whether these disparities affect health outcomes and devise new DDI measures for racial and ethnic minorities.
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Mao J, Chughtai B, Ibrahim S, Sedrakyan A. Food and Drug Administration Safety Communication on the Use of Transvaginal Mesh in Pelvic Organ Prolapse Repair Surgery: The Impact of Social Determinants of Health. Female Pelvic Med Reconstr Surg 2021; 27:e133-e138. [PMID: 32453208 PMCID: PMC7679269 DOI: 10.1097/spv.0000000000000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study was to examine the impact of the July 2011 Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse (POP) repair by patients' race and ethnicity. METHODS We conducted an observational cohort study of women undergoing POP repairs in 2008 to 2015 in New York State. We examined the changes in transvaginal mesh use in POP repairs before and after the FDA communication by patients' race and ethnicity. Piecewise logistic regression models were used to assess the trends of mesh use, adjusting for patient characteristics. We performed a subgroup analysis of the trends of transvaginal mesh use by racial groups, stratifying by patients' neighborhood socioeconomic status. RESULTS We included 49,848 women (78% white, 7% black, and 15% Hispanic) with an average ± SD age of 60.2 ± 13.0 years. After the safety communication, the use of transvaginal mesh in POP repairs decreased among white women (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.41-0.50) and African Americans (OR, 0.48; 95% CI, 0.35-0.67) but remained stable among Hispanic women (OR, 0.88; 95% CI, 0.70-1.11). Only in the subgroup of patients from high-income areas, there was a trend toward decreasing mesh use among Hispanic patients after 2011 (OR, 0.71; 95% CI, 0.49-1.04). CONCLUSIONS The communications related to the safety of transvaginal mesh did not have an equal impact across racial groups. Mesh use decreased among white and African American women but not among Hispanic women after the 2011 FDA safety communication. Particular attention is warranted for patients from disadvantaged groups, especially low-income minorities, when disseminating medical device safety messages.
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Affiliation(s)
- Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY
| | - Said Ibrahim
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
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Smith LB, Desai NR, Dowd B, Everhart A, Herrin J, Higuera L, Jeffery MM, Jena AB, Ross JS, Shah ND, Karaca-Mandic P. Patient and provider-level factors associated with changes in utilization of treatments in response to evidence on ineffectiveness or harm. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:299-317. [PMID: 32350680 PMCID: PMC7725279 DOI: 10.1007/s10754-020-09282-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
High-quality health care not only includes timely access to effective new therapies but timely abandonment of therapies when they are found to be ineffective or unsafe. Little is known about changes in use of medications after they are shown to be ineffective or unsafe. In this study, we examine changes in use of two medications: fenofibrate, which was found to be ineffective when used with statins among patients with Type 2 diabetes (ACCORD lipid trial); and dronedarone, which was found to be unsafe in patients with permanent atrial fibrillation (PALLAS trial). We examine the patient and provider characteristics associated with a decline in use of these medications. Using Medicare fee-for-service claims from 2008 to 2013, we identified two cohorts: patients with Type 2 diabetes using statins (7 million patient-quarters), and patients with permanent atrial fibrillation (83 thousand patient-quarters). We used interrupted time-series regression models to identify the patient- and provider-level characteristics associated with changes in medication use after new evidence emerged for each case. After new evidence of ineffectiveness emerged, fenofibrate use declined by 0.01 percentage points per quarter (95% CI - 0.02 to - 0.01) from a baseline of 6.9 percent of all diabetes patients receiving fenofibrate; dronedarone use declined by 0.13 percentage points per quarter (95% CI - 0.15 to - 0.10) from a baseline of 3.8 percent of permanent atrial fibrillation patients receiving dronedarone. For dronedarone, use declined more quickly among patients dually-enrolled in Medicare and Medicaid compared to Medicare-only patients (P < 0.001), among patients seen by male providers compared to female providers (P = 0.01), and among patients seen by cardiologists compared to primary care providers (P < 0.001).
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Affiliation(s)
- Laura Barrie Smith
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Nihar R Desai
- Cardiovascular Medicine, Yale School of Medicine, New Haven, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
| | - Bryan Dowd
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Alexander Everhart
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA
| | - Jeph Herrin
- Cardiovascular Medicine, Yale School of Medicine, New Haven, USA
| | - Lucas Higuera
- Health Economics and Outcomes Research - Cardiac Rhythm and Heart Failure, Medtronic, Minneapolis, USA
| | - Molly Moore Jeffery
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
- Emergency Medicine Research, Mayo Clinic, Rochester, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, USA
- Department of Medicine, Massachusetts General Hospital, Boston, USA
- National Bureau of Economic Research, Cambridge, MA, USA
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
- General Internal Medicine, Yale School of Medicine, New Haven, USA
- Health Policy and Management, Yale School of Public Health, New Haven, USA
| | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - Pinar Karaca-Mandic
- National Bureau of Economic Research, Cambridge, MA, USA.
- Carlson School of Management, University of Minnesota, Minneapolis, MN, USA.
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Cook BL, Wang Y, Sonik R, Busch S, Carson N, Progovac AM, Zaslavsky AM. Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning. Health Serv Res 2020; 54 Suppl 1:255-262. [PMID: 30666633 PMCID: PMC6341210 DOI: 10.1111/1475-6773.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION After the 2004 FDA box warning raised concerns about increased suicidal ideation among youth taking antidepressants, antidepressant use decreased for White youth but slightly increased for Black and Latino youth. Better understanding of patient and provider factors contributing to these differences is needed to improve future risk warning dissemination. METHODS We analyzed antidepressant prescriptions for youth aged 5-17 in 2002-2006 Medicaid claims data from four states (CA, FL, NC, and NY). In multilevel models, we assessed provider- and patient-level contributions to changes in antidepressant use by race/ethnicity and compared responses to the box warning between providers with large (>2/3) and small (<1/3) proportions of minority patients. RESULTS A significant amount of variance in overall prescribing patterns (calculated by the ICC) was explained at the provider level. Significant provider-level variation was also identified in the differential effect of the box warning by racial/ethnic group. In a test of the influence of provider panel mix, we found that providers with large proportions of minority patients reduced antidepressant prescribing more slowly after the box warning than other providers. DISCUSSION This study is the first to assess provider- and patient-level variation in the impact of a health care policy change on treatment disparities. Black and Latino youth Medicaid beneficiaries were seen by largely different providers than their White counterparts, and these distinct providers were influential in driving antidepressant prescription patterns following the box warning. Concerted outreach to providers of minority beneficiaries is needed to ensure that risk warnings and clinical innovations diffuse swiftly across racial/ethnic minority groups.
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Affiliation(s)
- Benjamin L Cook
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Ye Wang
- Disparities Research Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajan Sonik
- Tucker-Seeley Research Lab, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
| | - Susan Busch
- Yale School of Public Health, New Haven, Connecticut
| | - Nicholas Carson
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Ana M Progovac
- Health Equity Research Lab, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Carson N, Progovac A, Wang Y, Cook BL. A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills. Depress Anxiety 2017; 34:1147-1156. [PMID: 28962069 PMCID: PMC5895183 DOI: 10.1002/da.22681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/19/2017] [Accepted: 08/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Food and Drug Administration's 2004 antidepressant warning was followed by decreases in antidepressant prescribing for youth. This was due to declines in all types of depression treatment, not just the intended changes in antidepressant prescribing patterns. Little is known about how these patterns varied by race/ethnicity. METHOD Data are Medicaid claims from four U.S. states (2002-2009) for youth ages 5-17. Interrupted time series analyses measured changes due to the warning in levels and trends, by race/ethnicity, of three outcomes: antidepressant prescription fills, depression treatment visits, and incident fluoxetine prescription fills. RESULTS Prewarning, antidepressant fills were increasing across all racial/ethnic groups, fastest for White youth. Postwarning, there was an immediate drop and continued decline in the rate of fills among White youth, more than double the decline in the rate among Black and Latino youth. Prewarning, depression treatment visits were increasing for White and Latino youth. Postwarning, depression treatment stabilized among Latinos, but declined among White youth. Prewarning, incident fluoxetine fills were increasing for all groups. Postwarning, immediate increases and increasing trends of fluoxetine fills were identified for all groups. CONCLUSIONS Antidepressant prescription fills declined most postwarning for White youth, suggesting that risk information may have diffused less rapidly to prescribers or caregivers of minorities. Decreases in depression treatment visits help to explain the declines in antidepressant prescribing and were largest for White youth. An increase in incident fluoxetine fills, the only medication indicated for pediatric depression at the time, suggests that the warning may have shifted prescribing practices.
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Affiliation(s)
- Nicholas Carson
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School, 1035 Cambridge Street, Suite 26, Cambridge, MA 02141, Fax: (617) 806-8740, Office: (617) 617-5269
| | - Ana Progovac
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School
| | - Ye Wang
- Massachusetts General Hospital
| | - Benjamin L. Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance & Harvard Medical School
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The Impact of US FDA and Health Canada Warnings Related to the Safety of High-dose Simvastatin. Drugs Real World Outcomes 2017; 4:215-223. [PMID: 28956294 PMCID: PMC5684045 DOI: 10.1007/s40801-017-0116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Between 2010 and 2012, the US Food and Drug Administration and Health Canada issued warnings to healthcare professionals emphasizing the increased risk of muscle problems with high-dose simvastatin. Objective To measure the impact of the Health Canada safety warning regarding dose-dependent adverse effects of simvastatin on prescribing of low, medium, and high doses of simvastatin. Methods An interrupted time-series design was used to evaluate the impact of a Health Canada safety warning on 7 November 2012 regarding the safety of high-dose simvastatin. Monthly prescription records were analyzed for beneficiaries of the Nova Scotia Seniors’ Pharmacare Program aged 65 years or older who had received > 1 prescription of simvastatin between 1 January 1997 and 31 March 2015. Autoregressive Integrated Moving Average models were used to test changes in the proportion of beneficiaries dispensed a low dose (< 40 mg), medium dose (40 mg to < 80 mg), or high dose (≥ 80 mg) of simvastatin over time. Results There were 219 monthly periods, of which 29 periods occurred after the Health Canada warning. On average during the pre-warning periods there were 2944 simvastatin users per month, of whom 71% were dispensed a low dose, 26% a medium dose, and 2% a high dose. The proportion of beneficiaries dispensed low-dose simvastatin increased by 0.9% (one-sided p value 0.035; 90% CI 0.07–1.65), the proportion dispensed medium-dose simvastatin decreased by 0.7% (one-sided p value 0.0496; 90% CI −1.48 to −0), and there was no significant change in the proportion dispensed high-dose simvastatin (−0.15% change, one-sided p value 0.205; 90% CI −0.45 to 0.15). Conclusions The Health Canada Health Care Professional warning had a small effect on increasing the proportion of beneficiaries dispensed low and medium doses of simvastatin but not high doses of simvastatin. Nevertheless, there remain seniors in Nova Scotia receiving high-dose simvastatin for whom the benefit/risk potential may need to be re-evaluated.
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Cook BL, Carson NJ, Kafali EN, Valentine A, Rueda JD, Coe-Odess S, Busch S. Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment. Gen Hosp Psychiatry 2017; 45:32-39. [PMID: 28274336 PMCID: PMC7598773 DOI: 10.1016/j.genhosppsych.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment. METHODS Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics. RESULTS Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts. CONCLUSIONS Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.
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Affiliation(s)
- Benjamin Lê Cook
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States; Department of Psychiatry, Harvard Medical School, United States.
| | - Nicholas J. Carson
- Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States,Department of Psychiatry, Harvard Medical School, United States
| | | | - Anne Valentine
- Heller School for Social Policy and Management, United States.
| | | | | | - Susan Busch
- Yale School of Public Health, United States.
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Bushnell GA, Stürmer T, Swanson SA, White A, Azrael D, Pate V, Miller M. Dosing of Selective Serotonin Reuptake Inhibitors Among Children and Adults Before and After the FDA Black-Box Warning. Psychiatr Serv 2016; 67:302-9. [PMID: 26567938 PMCID: PMC5033112 DOI: 10.1176/appi.ps.201500088] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Prior research evaluated various effects of the 2004 black-box warning by the U.S. Food and Drug Administration (FDA) on the risk of suicidality among children associated with use of antidepressants, but the warning's effect on dosing of antidepressants has not been evaluated. This study estimated whether the initial antidepressant dose prescribed decreased and the proportion of patients who augmented the dose on the second fill increased following the 2004 warning and its 2007 expansion to young adults. METHODS The study utilized the LifeLink Health Plan Claims Database. The study cohort consisted of commercially insured children (ages 5-17), young adults (18-24), and adults (25-64) who initiated a selective serotonin reuptake inhibitor (SSRI) (citalopram, fluoxetine, paroxetine, or sertraline) from January 1, 2000, to December 31, 2009. Dose per day was determined by days' supply, strength, and quantity dispensed. Initiation with a low dose and augmentation of >1 mg/day on the second prescription before and after the 2004 warning were considered. RESULTS Of 51,948 children who initiated an SSRI, 15% initiated with a low dose before the 2004 warning compared with 31% after the warning; there was a smaller change among young adults (6 percentage points) and adults (3 percentage points). The overall increase in dose augmentations among children and young adults was driven by the increase in patients initiating with a low dose. CONCLUSIONS The proportion of commercially insured children initiating an SSRI with a low dose was higher after the 2004 FDA warning on the risk of suicidality among children, suggesting improved prescribing practices surrounding SSRI dosing among children.
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Affiliation(s)
- Greta A Bushnell
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Til Stürmer
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Sonja A Swanson
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Alice White
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Deborah Azrael
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Virginia Pate
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
| | - Matthew Miller
- Ms. Bushnell, Dr. Stürmer, Dr. White, and Ms. Pate are with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (e-mail: ). Dr. Swanson is with the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands, and the Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston. Dr. Azrael is with the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston. Dr. Miller is with the Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston
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Carson NJ, Vesper A, Chen CN, Lê Cook B. Quality of follow-up after hospitalization for mental illness among patients from racial-ethnic minority groups. Psychiatr Serv 2014; 65:888-96. [PMID: 24686538 PMCID: PMC4182296 DOI: 10.1176/appi.ps.201300139] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States. METHODS The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference. RESULTS Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge. CONCLUSIONS Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
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Affiliation(s)
- Nicholas J Carson
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Andrew Vesper
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Chih-Nan Chen
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
| | - Benjamin Lê Cook
- Dr. Carson and Dr. Cook are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston (e-mail: ). At the time of this research, Dr. Vesper was with the Department of Statistics, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts. Dr. Chen is with the Department of Economics, National Taipei University, Taipei, Taiwan
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