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Hwong AR, Vittinghoff E, Thomas M, Hermida R, Walkup J, Crystal S, Olfson M, Mangurian C. Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2023; 74:497-504. [PMID: 36226372 PMCID: PMC10104476 DOI: 10.1176/appi.ps.20220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia. METHODS Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates. RESULTS In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001). CONCLUSIONS Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Richard Hermida
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - James Walkup
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
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Leung KS, Parks J, Topolski J. Preventable hospitalizations among adult Medicaid beneficiaries with concurrent substance use disorders. Prev Med Rep 2015; 2:379-84. [PMID: 26844094 PMCID: PMC4721431 DOI: 10.1016/j.pmedr.2015.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE We aim to examine the relationships between substance use disorders and preventable hospitalizations for Ambulatory Care Sensitive Conditions among adult Medicaid beneficiaries. METHODS Cross-sectional analysis using de-identified Medicaid claims data in 2012 from 177,568 beneficiaries in Missouri was conducted. Logistic regression models were estimated for the associations of substance use disorder status with Ambulatory Care Sensitive Conditions, demographics, chronic physical and mental illnesses. Zero-inflated negative binomial regressions assessed substance use disorders, hospitalization for Ambulatory Care Sensitive Conditions, and length of hospital stay for Ambulatory Care Sensitive Conditions adjusting for co-morbid physical illnesses, mental illnesses and demographics. RESULTS Over 12% of the sample had been diagnosed for substance use disorder. Beneficiaries with substance use disorder were more likely than Nonsubstance use disorder beneficiaries to have admissions for chronic conditions including short/long-term complications of diabetes, uncontrolled diabetes, hypertension, chronic obstructive pulmonary disease/asthma, but not for acute conditions. While substance use disorder beneficiaries were more likely than Nonsubstance use disorder beneficiaries to be hospitalized for any Ambulatory Care Sensitive Conditions; there were no statistical differences between the two groups in terms of length of hospital stays. CONCLUSIONS Substance use disorder is statistically associated with hospitalizations for most Ambulatory Care Sensitive Conditions but not with length of hospital stay for Ambulatory Care Sensitive Conditions, after adjusting for covariates. The significant associations between substance use disorder and Ambulatory Care Sensitive Condition admissions suggest unmet primary health care needs for substance use disorder beneficiaries and a need for integrated primary/behavioral healthcare.
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Affiliation(s)
- Kit Sang Leung
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA
| | - Joe Parks
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA; Missouri Department of Social Services, 615 Howerton Court, PO Box 6500, Jefferson City, MO 65102-6500, USA
| | - James Topolski
- MIMH,University of Missouri - St. Louis, 4633 World Parkway Circle, St. Louis, MO 63134-3115, USA
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Abstract
PURPOSE Innovative workforce models are being developed and implemented to meet the changing demands of primary care. A literature review was conducted to construct a typology of workforce models used by primary care practices. METHODS Ovid Medline, CINAHL, and PsycInfo were used to identify published descriptions of the primary care workforce that deviated from what would be expected in the typical practice in the year 2000. Expert consultants identified additional articles that would not show up in a regular computerized search. Full texts of relevant articles were read and matrices for sorting articles were developed. Each article was reviewed and assigned to one of 18 cells in the matrices. Articles within each cell were then read again to identify patterns and develop an understanding of the full spectrum of workforce innovation within each category. RESULTS This synthesis led to the development of a typology of workforce innovations represented in the literature. Many workforce innovations added personnel to existing practices, whereas others sought to retrain existing personnel or even develop roles outside the traditional practice. Most of these sought to minimize the impact on the existing practice roles and functions, particularly that of physicians. The synthesis also identified recent innovations which attempted to fundamentally transform the existing practice, with transformation being defined as a change in practice members' governing variables or values in regard to their workforce role. CONCLUSIONS Most conceptualizations of the primary care workforce described in the literature do not reflect the level of innovation needed to meet the needs of the burgeoning numbers of patients with complex health issues, the necessity for roles and identities of physicians to change, and the call for fundamentally redesigned practices. However, we identified 5 key workforce innovation concepts that emerged from the literature: team care, population focus, additional resource support, creating workforce connections, and role change.
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