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Humphreys K, Andrews C, Frank RG. Progress and Challenges in Medicaid-Financed Care of Substance Use Disorder. Am J Psychiatry 2024; 181:359-361. [PMID: 38706337 DOI: 10.1176/appi.ajp.20230804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Keith Humphreys
- Center for Innovation to Implementation, Veterans Affairs Health Care System, Palo Alto, Calif.; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif. (Humphreys); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, S,C, (Andrews); Schaeffer Initiative on Health Policy, Economics Studies, The Brookings Institution, Washington, D.C. (Frank)
| | - Christina Andrews
- Center for Innovation to Implementation, Veterans Affairs Health Care System, Palo Alto, Calif.; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif. (Humphreys); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, S,C, (Andrews); Schaeffer Initiative on Health Policy, Economics Studies, The Brookings Institution, Washington, D.C. (Frank)
| | - Richard G Frank
- Center for Innovation to Implementation, Veterans Affairs Health Care System, Palo Alto, Calif.; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif. (Humphreys); Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, S,C, (Andrews); Schaeffer Initiative on Health Policy, Economics Studies, The Brookings Institution, Washington, D.C. (Frank)
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Lee D, Dugan JA. Medicaid Expansions and Access to Substance Abuse Treatment Services Among Limited English Proficiency Populations. Med Care 2023; 61:858-865. [PMID: 37782461 PMCID: PMC10635341 DOI: 10.1097/mlr.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Although the myriad of provisions under the Affordable Care Act (ACA) have generally increased coverage and financial access to the health systems, language barriers represent a serious challenge to access to care among Limited English Proficiency (LEP) populations. OBJECTIVE The aim of this study was to examine the effect of Medicaid expansions under the ACA on the availability of language services and Medicaid acceptance in substance abuse treatment (SAT) facilities. RESEARCH DESIGN A quasi-experimental difference-in-differences design with multiple time periods was used to compare changes in the availability of language services and Medicaid as a payment source between Medicaid expansion and nonexpansion states. Facility-level observational data in the National Survey of Substance Abuse Treatment Services 2010-2019 was included. MEASURES Availability of LEP services and Medicaid acceptance in the SAT facilities. RESULTS The proportion of SAT facilities that provide LEP services increased from 40% in 2013 to 53% in 2019. The proportions by state are heterogeneous, ranging from approximately 20% to 70%. The ACA Medicaid expansions are not associated with changes in the availability of LEP services in the facilities. Moreover, Medicaid acceptance in the expansion states increased gradually following the expansion; however, the estimates are not statistically significant. CONCLUSION The ACA Medicaid expansion had no impact on the availability of LEP services and the acceptance of Medicaid as a payment source in the SAT facilities.
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Affiliation(s)
- Donghoon Lee
- Department of Health Policy and Management, College of Health Science, Korea University, BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Jerome A. Dugan
- Department of Health Systems and Population Health
- Evans School of Public Policy & Governance, University of Washington, Seattle, WA
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Tilhou AS, Murray E, Wang J, Linas BP, White L, Samet JH, LaRochelle M. Trends in buprenorphine dosage and days supplied for new treatment episodes for opioid use disorder, 2010-2019. Drug Alcohol Depend 2023; 252:110981. [PMID: 37839942 PMCID: PMC10615721 DOI: 10.1016/j.drugalcdep.2023.110981] [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] [Received: 06/26/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Buprenorphine reduces risk of opioid overdose mortality. However, its benefits are limited by low retention, particularly in early treatment. Optimizing initial dosage may impact retention. However, little is known about the prescription characteristics of new buprenorphine treatment episodes. METHODS In a US sample of commercial and employer-sponsored pharmacy claims, we identified new buprenorphine treatment episodes (days 1-30) from individuals ≥16 years following 90 days without buprenorphine from 2010 to 2019. Outcomes included first prescription average days supplied, first prescription average daily dosage, and average dosage on days 2, 8, 15 and 30. RESULTS We identified 117,793 new episodes among 96,451 unique individuals. Episodes per 10,000 person-years decreased slightly over time. Stratifying by age, sex and region demonstrated decreasing episodes among individuals ≤34 years and increasing episodes among individuals ≥35 years. From 2010-2019, first prescription average days supplied and daily dosage decreased from 17.1 to 15.3 days and 13.6mg to 11.6mg, respectively. Simultaneously, the proportion of episodes without possession and with dosages <16mg increased across all days and years. By day 30, episodes without buprenorphine possession grew from 27.9% to 30.8% and episodes involving dosages of <16mg grew from 26.4% to 33.4%. CONCLUSIONS We found that buprenorphine dosage and days supplied for new treatment episodes decreased from 2010 to 2019 while buprenorphine possession worsened. Further investigation examining the relationship between buprenorphine dosage and retention in the early treatment period is needed.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston Medical Center, 771 Albany St., Dowling 5 South, Boston, MA 02118, United States; Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St., Boston, MA 02118, United States.
| | - Eleanor Murray
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, United States
| | - Jiayi Wang
- Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States
| | - Benjamin P Linas
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Section of Infectious Diseases, Boston Medical Center, 725 Albany St 9th Floor, Boston, MA 02118, United States
| | - Laura White
- Department of Biostatistics, Boston University School of Public Health, 715 Albany St., Boston, MA 02118, United States
| | - Jeffrey H Samet
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Ave 6th Floor, Boston, MA 02118, United States
| | - Marc LaRochelle
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord St., Boston, MA 02118, United States; Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Ave 6th Floor, Boston, MA 02118, United States
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Abraham AJ, Lawler EC, Harris SJ, Bagwell Adams G, Bradford WD. Spillover of Medicaid Expansion to Prescribing of Opioid Use Disorder Medications in Medicare Part D. Psychiatr Serv 2022; 73:418-424. [PMID: 34407628 DOI: 10.1176/appi.ps.202000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined whether there were positive spillovers in opioid use disorder medication prescribing to Medicare Part D beneficiaries in Medicaid expansion states. Although prior studies have shown several positive benefits of Medicaid expansion for Americans with opioid use disorder, research has not examined potential spillovers to Medicare beneficiaries who have been hit hard by the opioid crisis. METHODS Prescribing data were taken from the Medicare Part D Prescription Public Use File (2010-2017). A difference-in-differences linear regression framework was used to identify spillovers in prescribing of buprenorphine and injectable naltrexone to Medicare Part D beneficiaries in Medicaid expansion states. Three sets of dependent variables measured medication prescribing at the county-year level (N=24,850). All models included county and year fixed effects, with standard errors clustered at the state level to address within-state serial correlation. RESULTS Medicaid expansion was associated with an increase in the probability of a county having an injectable naltrexone provider (p<0.01). After expansion, the number of buprenorphine providers in expansion states increased by 5.6% (p<0.05), and the number of injectable naltrexone providers increased by 3.3% (p<0.01), relative to nonexpansion states. Expansion was associated with a 23.1% (p<0.01) increase in the number of daily doses of injectable naltrexone, relative to nonexpansion states. CONCLUSIONS Medicaid expansion states may be better equipped to address the opioid crisis because of direct benefits to Medicaid beneficiaries and availability of opioid use disorder medications for Medicare Part D beneficiaries. However, additional efforts are likely needed to close the opioid use disorder treatment gap for Medicare beneficiaries.
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Affiliation(s)
- Amanda J Abraham
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Emily C Lawler
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Samantha J Harris
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - Grace Bagwell Adams
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
| | - W David Bradford
- School of Public and International Affairs (Abraham, Lawler, Bradford) and College of Public Health (Bagwell Adams), University of Georgia, Athens; Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Harris)
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Knudsen HK, Hartman J, Walsh SL. The effect of Medicaid expansion on state-level utilization of buprenorphine for opioid use disorder in the United States. Drug Alcohol Depend 2022; 232:109336. [PMID: 35123365 PMCID: PMC8885876 DOI: 10.1016/j.drugalcdep.2022.109336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Research on the impact of Medicaid expansion on buprenorphine utilization has largely focused on the Medicaid program. Less is known about its associations with total buprenorphine utilization and non-Medicaid payers. METHODS Monthly prescription data (June 2013-May 2018) for proprietary and generic sublingual as well as buccal buprenorphine products were purchased from IQVIA®. Population-adjusted state-level utilization measures were constructed for Medicaid, commercial insurance, Medicare, cash, and total utilization. A difference-in-differences (DID) approach with population weights estimated the association between Medicaid expansion and buprenorphine utilization, while controlling for treatment capacity. RESULTS Monthly total buprenorphine prescriptions increased by 68% overall and increased 283% for Medicaid, 30% for commercial insurance, and 143% for Medicare. Cash prescriptions decreased by 10%. The DID estimate for Medicaid expansion was not statistically significant for total utilization (-19.780, 95% CI = -45.118, 5.558, p = .123). For Medicaid buprenorphine utilization, there was a significant increase of 27.120 prescriptions per 100,000 total state residents (95% CI = 9.458, 44.782, p = .003) in expansion states versus non-expansion states post-Medicaid expansion. Medicaid expansion had a negative effect on commercial insurance (DID estimate = -37.745, 95% CI = -62.946, -12.544, p = .004), cash utilization (DID estimate = -6.675, 95% CI = -12.627, -0.723, p = .029), and Medicare utilization (DID estimate = -1.855, 95% CI = -3.697, -0.013, p = .048). DISCUSSION The associations between Medicaid expansion and buprenorphine utilization varied across different types of payers, such that the overall impact of Medicaid expansion on buprenorphine utilization was not significant.
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Affiliation(s)
- Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA.,Corresponding author: Hannah K. Knudsen, PhD, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508. Telephone: (859) 323-3947; fax: (859) 257-5232;
| | - Jeanie Hartman
- Substance Use Research Priority Area, University of Kentucky, 845 Angliana Avenue, Room 121, Lexington, KY 40508, USA.
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA
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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Neighbors CJ, Yerneni R, Sun Y, Choi S, Burke C, O’Grady MA, McDonald R, Morgenstern J. Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population. Subst Abuse 2022; 16:11782218221075041. [PMID: 35125871 PMCID: PMC8808013 DOI: 10.1177/11782218221075041] [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: 05/26/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
AIMS We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. METHODS We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. RESULTS CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. CONCLUSION Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.
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Affiliation(s)
- Charles J Neighbors
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Yi Sun
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | - Sugy Choi
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Constance Burke
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | | | - Rebecca McDonald
- Center on Addiction, New York, NY, USA
- King’s College London, London, UK
| | - Jon Morgenstern
- Center on Addiction, New York, NY, USA
- Northwell Health, New Hyde Park, NY, USA
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Abstract
OBJECTIVE The authors examined changes in buprenorphine treatment following Medicaid expansion, including the contribution of Medicaid-financed prescriptions. METHODS Buprenorphine pharmacy claims for patients were identified in the 2012-2018 IQVIA Longitudinal Prescription Data (LRx) data set, including 79.8% of U.S. retail prescriptions in 2012, increasing to 92.0% in 2018. A cohort analysis was used to assess the mean number of patients in a yearly quarter filling one or more buprenorphine prescriptions during preexpansion (2012-2013) and postexpansion (2014-2018) periods in expansion and nonexpansion states. Interrupted time-series analysis estimated associations of Medicaid expansion period with change in Medicaid-financed treatment. Separate analyses evaluated changes in duration and dose of new treatment episodes focused on mean quarterly number of patients treated with buprenorphine and proportions of new treatment episodes ≥180 days long and with ≥16 mg/day. RESULTS Between preexpansion and postexpansion, the mean quarterly number of patients taking buprenorphine increased by 93,300 in expansion states and by 84,960 in nonexpansion states. Corresponding changes for Medicaid-financed patients were 28,760 and 4,050, respectively. The fastest growth in Medicaid-financed treatment occurred among patients ages 25-44. Among new Medicaid-financed treatment episodes, little change was found in the proportion reaching the 180-day threshold, and declines were observed in the proportion receiving ≥16 mg/day. CONCLUSIONS The findings are consistent with previous research indicating that Medicaid expansion has increased Medicaid-financed buprenorphine treatment. However, because of offsetting changes in other payment groups, the overall increase in expansion states was similar to the increase in nonexpansion states.
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Affiliation(s)
- Mark Olfson
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Victoria Shu Zhang
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Marissa King
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
| | - Ramin Mojtabai
- Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York City (Olfson); School of Management, Yale University, New Haven, Connecticut (Zhang, King); Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Mojtabai)
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Ensuring access to high-quality substance use disorder treatment for Medicaid enrollees: A qualitative study of diverse stakeholders' perspectives. J Subst Abuse Treat 2021; 129:108511. [PMID: 34176694 DOI: 10.1016/j.jsat.2021.108511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medicaid programs are vital to ensure low-income individuals have access to substance use disorder (SUD) treatment. However, shifts in Medicaid policies may alter coverage and SUD care for this population, who already face difficulties receiving high-quality SUD treatment. Using a policy implementation research approach, we sought to identify barriers and facilitators when transitioning from Medicaid fee-for-service to managed care plan structures and opportunities for improving SUD care in New York State (NYS). METHOD Study staff conducted semistructured, in-depth qualitative interviews (N = 40 total) with diverse stakeholders involved with different aspects of SUD treatment in NYS, including policy leaders (n = 13), clinicians (n = 12), Medicaid managed care plan administrators (n = 5), and patients (n = 10). RESULTS Findings from thematic analysis centered on three themes: 1) while transitions to managed care have benefited clinicians, certain policies affect patients' Medicaid enrollment and quality of care; 2) stakeholders perceived individuals with dual diagnoses, older adults, and linguistic minorities to be at higher risk for inadequate care; and 3) current quality metrics may not adequately capture treatment quality. CONCLUSION Policy changes should focus on promoting increased collaboration among stakeholders, expanding Medicaid coverage, and reducing stigma. Resources should be diverted to facilitate psychiatric care for patients with dual diagnoses and to build workforce capacity to adequately meet the needs of older adults and linguistic minorities. Opportunities for NYS Medicaid include adapting performance metrics to capture meaningful patient outcomes and link reimbursements to improvements in patients' quality of life.
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Dennis ML, Davis JP. Screening for more with less: Validation of the Global Appraisal of Individual Needs Quick v3 (GAIN-Q3) screeners. J Subst Abuse Treat 2021; 126:108414. [PMID: 34116811 DOI: 10.1016/j.jsat.2021.108414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Multi-morbidity is the norm among adolescents and adults with substance use and other mental disorders and warrants a multi-pronged screening approach. However, the time constraints on assessment inherent in clinical practice often temper the desire for a full understanding of multi-morbidity problems. The 15- to 25-minute Global Appraisal of Individual Needs Quick version 3 (GAIN-Q3) includes screeners for 9 common clinical problems that are short (4 to 10 items) and provide dimensional measures of problem severity in each area that are also categorized to guide clinical decision making. The screeners are summed into a total score that represents a 10th screener for multi-morbidity. This paper provides background on the development of the GAIN-Q3 screeners, their psychometric behaviors, efficiency, and predictive power relative to the 1-2 h full GAIN-I. Based on literature showing differential item and scale functioning by age, analyses were conducted separately using data from 10,625 adolescent and 10,167 adult treatment clients. Despite the condensed lengths of the screening measures compared with their longer versions, the reliability estimates are within the good to excellent range (0.7 to 0.9) in terms of internal consistency for 6 of the 10 screeners for adolescents and 7 of the 10 screeners for adults. In addition, the part to whole correlation for all 10 comparisons for both adolescents and adults are excellent (0.82 to 0.96). Moreover, there is strong evidence for the measures' convergent and discriminant validity and efficiency (i.e., maximum information gathered in as few items possible) relative to the full-length scales as well as relative to other scales in the full GAIN-I. Analyses of the interpretive cut-scores provide accurate identification of cases with high sensitivity and specificity, thus supporting the screeners' capacity to triage. PUBLIC SIGNIFICANCE STATEMENT: This study reports on the ability (GAIN-Q3) to efficiently screen for multiple co-occurring substance use, mental health, and associated problems. Multi-problem presentation in the social service sector is the normal expectation, yet time constraints prevent broad assessment of potentially many problematic areas. The GAIN-Q3 showed convergent and discriminant validity relative to the full-length scales as well as other scales assessed in the GAIN-I. The GAIN-Q3 achieves the desired balance between broad coverage and measurement efficiency to provide ample information to identify the best course of action for an individual.
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Affiliation(s)
- Michael L Dennis
- Chestnut Health Systems, GAIN Coordinating Center, Normal, IL, United States of America.
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California, United States of America
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Park SE, Mosley JE, Grogan CM, Pollack HA, Humphreys K, D'Aunno T, Friedmann PD. Patient-centered care's relationship with substance use disorder treatment utilization. J Subst Abuse Treat 2020; 118:108125. [PMID: 32972650 PMCID: PMC7528396 DOI: 10.1016/j.jsat.2020.108125] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Calls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services. METHODS Using nationally representative survey data from SUD treatment clinics in the United States, we examine the association between patient-centered clinical care and the utilization of six services: methadone, buprenorphine, behavioral treatment, routine medical care, HIV testing, and suicide prevention counseling. We measured clinics' practice of and emphasis on patient-centered care with two variables: (1) whether the clinic regularly invites patients into clinical decision-making processes, and (2) whether supervisors believe in patient-centered healthcare and shared decision-making practices within their clinics. RESULTS In 2017, only 23% of SUD treatment clinics regularly invited patients into care decision-making meetings when their cases were discussed. A composite variable captured clinical supervisors' own experience with and expectations for patient-clinician interaction within their clinics (Cronbach's alpha = 0.79). Results from regression models that controlled for several organizational and environmental factors show that patient-centered care was independently associated with greater utilization of four of six evidence-based services. CONCLUSIONS A minority of SUD clinics practice patient-centered healthcare in the United States. Given the connection to evidence-based services, increasing participatory mechanisms in SUD treatment service provision can facilitate patients' access to appropriate and evidence-based services.
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Affiliation(s)
| | | | | | | | - Keith Humphreys
- Veterans Affairs and Stanford University Medical Centers, USA
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Satre DD, Palzes VA, Young-Wolff KC, Parthasarathy S, Weisner C, Guydish J, Campbell CI. Healthcare utilization of individuals with substance use disorders following Affordable Care Act implementation in a California healthcare system. J Subst Abuse Treat 2020; 118:108097. [PMID: 32972648 DOI: 10.1016/j.jsat.2020.108097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/24/2020] [Accepted: 07/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Practitioners expected the Affordable Care Act (ACA) to increase availability of health services and access to treatment for Americans with substance use disorders (SUDs). Yet research has not examined the associations among ACA enrollment mechanisms, deductibles, and the use of SUD treatment and other healthcare services. Understanding these relationships can inform future healthcare policy. METHODS We conducted a longitudinal analysis of patients with SUDs newly enrolled in the Kaiser Permanente Northern California health system in 2014 (N = 6957). Analyses examined the likelihood of service utilization (primary care, specialty SUD treatment, psychiatry, inpatient, and emergency department [ED]) over three years after SUD diagnosis, and associations with enrollment mechanisms (ACA Exchange vs. other), deductibles (none, $1-$999 [low] and ≥$1000 [high]), membership duration, psychiatric comorbidity, and demographic characteristics. We also evaluated whether the enrollment mechanism moderated the associations between deductible limits and utilization likelihood. RESULTS Service utilization was highest in the 6 months after SUD diagnosis, decreased in the following 6 months, and remained stable in years 2-3. Relative to patients with no deductible, those with a high deductible had lower odds of using all health services except SUD treatment; associations with primary care and psychiatry were strongly negative among Exchange enrollees. Among non-Exchange enrollees, patients with deductibles were more likely than those without deductibles to receive SUD treatment. Exchange enrollment compared to other mechanisms was associated with less ED use. Psychiatric comorbidity was associated with greater use of all services. Nonwhite patients were less likely to initiate SUD and psychiatry treatment. CONCLUSIONS Higher deductibles generally were associated with use of fewer health services, especially in combination with enrollment through the Exchange. The role of insurance factors, psychiatric comorbidity and race/ethnicity in health services for people with SUDs are important to consider as health policy evolves.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America.
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Kelly C Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Constance Weisner
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
| | - Joseph Guydish
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, San Francisco, CA 94118, United States of America
| | - Cynthia I Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612, United States of America
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Park SE, Grogan CM, Mosley JE, Humphreys K, Pollack HA, Friedmann PD. Correlates of Patient-Centered Care Practices at U.S. Substance Use Disorder Clinics. Psychiatr Serv 2020; 71:35-42. [PMID: 31500544 PMCID: PMC6939146 DOI: 10.1176/appi.ps.201900121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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 Substance use disorder treatment professionals are paying increased attention to implementing patient-centered care. Understanding environmental and organizational factors associated with clinicians' efforts to engage patients in clinical decision-making processes is essential for bringing patient-centered care to the addictions field. This study examined factors associated with patient-centered care practices in substance use disorder treatment. METHODS Data were from the 2017 National Drug Abuse Treatment System Survey, a nationally representative survey of U.S substance use disorder treatment clinics (outpatient nonopioid treatment programs, outpatient opioid treatment programs, inpatient clinics, and residential clinics). Multivariate regression analyses examined whether clinics invited patients into clinical decision-making processes and whether clinical supervisors supported and believed in patient-centered care practices. RESULTS Of the 657 substance use disorder clinics included in the analysis, about 23% invited patients to participate in clinical decision-making processes. Clinicians were more likely to engage patients in decision-making processes when working in residential clinics (compared with outpatient nonopioid treatment programs) or in clinics serving a smaller proportion of patients with alcohol or opioid use disorder. Clinical supervisors were more likely to value patient-centered care practices if the organization's administrative director perceived less regional competition or relied on professional information sources to understand developments in the substance use disorder treatment field. Clinicians' tendency to engage patients in decision-making processes was positively associated with clinical supervisors' emphasis on patient-centered care. CONCLUSIONS A minority of U.S. substance use disorder clinics invited patients into clinical decision-making processes. Therefore, patient-centered care may be unavailable to certain vulnerable patient groups.
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Affiliation(s)
- Sunggeun Ethan Park
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Colleen M Grogan
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Jennifer E Mosley
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Keith Humphreys
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Harold A Pollack
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
| | - Peter D Friedmann
- School of Social Work, University of Michigan, Ann Arbor (Park); School of Social Service Administration, University of Chicago, Chicago (Grogan, Mosley, Pollack); Health Services Research & Development, U.S. Department of Veterans Affairs Medical Center, Palo Alto, California, and Department of Psychiatry, Stanford University Medical Center, Stanford, California (Humphreys); Department of Medicine, University of Massachusetts--Baystate, and Office of Research, Baystate Health, Springfield, Massachusetts (Friedmann)
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Shover CL, Abraham A, D'Aunno T, Friedmann PD, Humphreys K. The relationship of Medicaid expansion to psychiatric comorbidity care within substance use disorder treatment programs. J Subst Abuse Treat 2019; 105:44-50. [PMID: 31443890 DOI: 10.1016/j.jsat.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/31/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Co-occurring mental health disorders are common among substance use disorder (SUD) patients. Medicaid expansion aimed to reduce barriers to SUD and mental health care and thereby improve treatment outcomes. METHODS We estimated change in the proportion of United States SUD treatment sites offering treatment for psychiatric comorbidities following Medicaid expansion as part of implementation of the Affordable Care Act (ACA) in 2014. Using panel data from the 2013-2014, n = 660, and 2016-2017, n = 638, waves of the National Drug Abuse Treatment System Survey (NDATSS), we estimated change in the proportion of sites offering antidepressant medication, other psychiatric medication, behavioral treatment, or any combination thereof for treatment of mental health comorbidities (i.e., beyond services focused on SUD). We modeled the impact of Medicaid expansion as an interaction between year and date of Medicaid expansion. We constructed a mixed-effects linear regression model for each outcome, with the interaction variable as the main exposure, site as a random effect, and site's average duration of treatment, proportion of clients with psychiatric comorbidities, average caseload per treatment prescribing-clinician on staff, type of facility and geographic region as covariates, to estimate a difference-in-differences (D-I-D) equation. RESULTS The adjusted D-I-D analysis indicated that the proportion of SUD treatment sites offering antidepressants for psychiatric treatment increased 10% (95% CI 1%, 18%) in the Medicaid expansion sites compared to non-expansion sites. The D-I-D for other psychiatric medications was also 10% (95% 1%, 19%). No significant changes were observed in behavioral treatment or the combination measure. The strongest association between Medicaid expansion and offering medication for mental health comorbidities was the 34% increase observed for residential treatment settings (95% CI 10%, 59%). CONCLUSION Availability of psychiatric medication treatment in SUD treatment settings increased following Medicaid expansion, particularly in residential SUD facilities. This policy change has facilitated integrated treatment for the substantial share of SUD treatment patients with mental health comorbidities, with the greatest benefit for patients receiving SUD treatment in residential programs.
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Affiliation(s)
- Chelsea L Shover
- Stanford University, Department of Psychiatry, 401 N. Quarry Rd., Stanford, CA 94305, United States of America.
| | - Amanda Abraham
- University of Georgia, School of Public and International Affairs, 280F Baldwin Hall, Athens, GA 30602, United States of America.
| | - Thomas D'Aunno
- New York University, Wagner Graduate School of Public Service, 295 Lafayette St., New York, NY 10012, United States of America.
| | - Peter D Friedmann
- University of Massachusetts Medical School - Baystate, Office of Research, 3601 Main St., Springfield, MA 01107, United States of America.
| | - Keith Humphreys
- Stanford University, Department of Psychiatry, 401 N. Quarry Rd., Stanford, CA 94305, United States of America; Veterans Affairs Palo Alto Health Care System, 795 Willow Rd., Menlo Park, CA 94025, United States of America.
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15
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Campbell CI, Parthasarathy S, Altschuler A, Young-Wolff KC, Satre DD. Characteristics of patients with substance use disorder before and after the Affordable Care Act. Drug Alcohol Depend 2018; 193:124-130. [PMID: 30366189 PMCID: PMC6703160 DOI: 10.1016/j.drugalcdep.2018.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation. METHODS In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures. RESULTS Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans. CONCLUSIONS Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.
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Affiliation(s)
- Cynthia I. Campbell
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA,Correspondence: Cynthia Campbell, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403, Tel: 510 891-3584, Fax: 510 891-3606,
| | - Sujaya Parthasarathy
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rd Floor, Oakland, CA 94612 USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143 USA
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16
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Manuel JI, Stebbins MB, Wu E. Gender Differences in Perceived Unmet Treatment Needs Among Persons With and Without Co-occurring Disorders. J Behav Health Serv Res 2018; 45:1-12. [PMID: 27507243 DOI: 10.1007/s11414-016-9530-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008-2013 National Survey on Drug Use and Health (unweighted N = 37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.
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Affiliation(s)
- Jennifer I Manuel
- New York University Silver School of Social Work, New York, NY, USA.
| | - Mary B Stebbins
- Virginia Commonwealth University School of Social Work, Richmond, VA, USA
| | - Elwin Wu
- Columbia University School of Social Work, New York, NY, USA
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17
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Grogan CM, Andrews C, Abraham A, Humphreys K, Pollack HA, Smith BT, Friedmann PD. Survey Highlights Differences In Medicaid Coverage For Substance Use Treatment And Opioid Use Disorder Medications. Health Aff (Millwood) 2018; 35:2289-2296. [PMID: 27920318 DOI: 10.1377/hlthaff.2016.0623] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act requires state Medicaid programs to cover substance use disorder treatment for their Medicaid expansion population but allows states to decide which individual services are reimbursable. To examine how states have defined substance use disorder benefit packages, we used data from 2013-14 that we collected as part of an ongoing nationwide survey of state Medicaid programs. Our findings highlight important state-level differences in coverage for substance use disorder treatment and opioid use disorder medications across the United States. Many states did not cover all levels of care required for effective substance use disorder treatment or medications required for effective opioid use disorder treatment as defined by American Society of Addiction Medicine criteria, which could result in lack of access to needed services for low-income populations.
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Affiliation(s)
- Colleen M Grogan
- Colleen M. Grogan is a professor at the School of Social Service Administration, University of Chicago, in Illinois
| | - Christina Andrews
- Christina Andrews is an assistant professor at the College of Social Work, University of South Carolina, in Columbia
| | - Amanda Abraham
- Amanda Abraham is an assistant professor in the Department of Public Administration and Policy at the University of Georgia, in Athens
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences in the Department of Psychiatry at the Stanford School of Medicine, in California
| | - Harold A Pollack
- Harold A. Pollack is the Helen Ross Professor at the School of Social Service Administration, University of Chicago
| | - Bikki Tran Smith
- Bikki Tran Smith is a doctoral student at the School of Social Service Administration, University of Chicago
| | - Peter D Friedmann
- Peter D. Friedmann is chief research officer at Baystate Health, in Springfield, Massachusetts
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18
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Abraham AJ, Andrews CM, Grogan CM, D'Aunno T, Humphreys KN, Pollack HA, Friedmann PD. The Affordable Care Act Transformation of Substance Use Disorder Treatment. Am J Public Health 2018; 107:31-32. [PMID: 27925819 DOI: 10.2105/ajph.2016.303558] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda J Abraham
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Christina M Andrews
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Colleen M Grogan
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Thomas D'Aunno
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Keith N Humphreys
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Harold A Pollack
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
| | - Peter D Friedmann
- Amanda J. Abraham is with the Department of Public Administration and Policy, University of Georgia, Athens. Christina M. Andrews is with the College of Social Work, University of South Carolina, Columbia. Colleen M. Grogan and Harold A. Pollack are with the School of Social Service Administration, University of Chicago, Chicago, IL. Thomas D'Aunno is with the Robert F. Wagner Graduate School of Public Service and College of Global Public Health, New York University, New York, NY. Keith N. Humphreys is with the Veterans Affairs Palo Alto Health Care System, Livermore, CA.Peter D. Friedmann is with the University of Massachusetts Medical School - Baytstate and Baystate Health, Springfield
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Tran Smith B, Seaton K, Andrews C, Grogan CM, Abraham A, Pollack H, Friedmann P, Humphreys K. Benefit requirements for substance use disorder treatment in state health insurance exchanges. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:426-430. [PMID: 29261341 DOI: 10.1080/00952990.2017.1411934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations. OBJECTIVE How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls. METHODS Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey. RESULTS States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used. CONCLUSION Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.
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Affiliation(s)
- Bikki Tran Smith
- a School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Kathleen Seaton
- b Department of Psychiatry , School of Medicine, Stanford University , Stanford , CA , USA
| | - Christina Andrews
- c College of Social Work , University of South Carolina , Columbia , SC , USA
| | - Colleen M Grogan
- a School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Amanda Abraham
- d Department of Medicine , Division of General Internal Medicine, University of Massachusetts-Baystate , Springfield , MA
| | - Harold Pollack
- a School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Peter Friedmann
- e University of Massachusetts , Medical School , Springfield , MA , USA
| | - Keith Humphreys
- b Department of Psychiatry , School of Medicine, Stanford University , Stanford , CA , USA
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Kulesza M, Watkins KE, Ober AJ, Osilla KC, Ewing B. Internalized stigma as an independent risk factor for substance use problems among primary care patients: Rationale and preliminary support. Drug Alcohol Depend 2017; 180:52-55. [PMID: 28869858 PMCID: PMC5648632 DOI: 10.1016/j.drugalcdep.2017.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little is known about internalized stigma among primary care patients, and whether the presence of internalized stigma is related to the severity of substance use problems independent of substance use-related variables. We sought to examine the relationship between internalized stigma and substance use problems among primary care patients with opioid or alcohol use disorders (OAUDs). METHODS We present baseline data from 393 primary care patients who were enrolled in a study of collaborative care for OAUDs. Regression analyses examined the relationship between internalized stigma and substance use problems, controlling for demographics, psychiatric comorbidity, and quantity/frequency of use. RESULTS The majority of participants reported thinking, at least sometimes, that they "have permanently screwed up" their lives (60%), and felt "ashamed" (60%), and "out of place in the world" (51%) as a result of their opioid or alcohol use. Higher internalized stigma was significantly related to more substance use problems (β=2.68, p<0.01), even after the effects of covariates were accounted for. Stigma added 22%, out of 51% total variance explained, leading to a significant improvement in prediction of substance use problems. CONCLUSIONS Among this group of primary care patients with OAUDs, rates of internalized stigma were comparable to those reported in specialty substance use treatment settings. Consistent with extant specialty care literature, our results suggest that internalized stigma may be a unique contributor that is associated with treatment outcomes, such as substance use problems, among primary care patients with OAUDs.
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Affiliation(s)
| | | | - Allison J Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Karen C Osilla
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Brett Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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21
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Manuel JI. The Grand Challenge of Reducing Gender and Racial/Ethnic Disparities in Service Access and Needs Among Adults with Alcohol Misuse. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2017; 17:10-35. [PMID: 30983911 PMCID: PMC6456903 DOI: 10.1080/1533256x.2017.1302887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examined the impact of the Affordable Care Act (ACA) on gender and racial/ethnic disparities in accessing and using behavioral health services among a national sample of adults who reported heavy/binge alcohol use (n=52,496) and those with alcohol use disorder (n=22,966). Difference-in-differences models estimated service-related disparities before (2008-2009) and after (2011-2014) health care reform. A sub-analysis was conducted before (2011-2013) and after (2014) full implementation of the ACA. Asian subgroups among respondents with heavy/binge drinking were excluded from SUD treatment and unmet need outcome models due to insufficient cell size. Among heavy/binge drinkers, unmet SUD treatment need decreased among Black women and increased among Black men. MH treatment decreased among Asian men, whereas unmet MH treatment need decreased among Hispanic men. MH treatment increased among Hispanic women with AUD. While there were improvements in service use and access among Black and Hispanic women and Hispanic men, there were setbacks among Black and Asian men. Implications for social workers are discussed.
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Affiliation(s)
- Jennifer I Manuel
- Assistant Professor, Silver School of Social Work, New York University, New York, NY, USA
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Knudsen HK, Studts JL. Perceived Impacts of the Affordable Care Act: Perspectives of Buprenorphine Prescribers. J Psychoactive Drugs 2017; 49:111-121. [PMID: 28296579 DOI: 10.1080/02791072.2017.1295335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Affordable Care Act (ACA) has been heralded as a major policy change that is expected to transform the delivery of substance use disorder (SUD) treatment. Few studies have reported on the perceived impacts of ACA from the perspectives of SUD treatment providers, such as physicians who prescribe buprenorphine to patients with opioid use disorder. The present study describes buprenorphine prescribers' perceptions regarding impacts of the ACA on the delivery of buprenorphine and examines whether state-level approaches to implementing ACA are associated with its perceived impacts. Data are drawn from a national sample of current buprenorphine prescribers (n = 1,174) who were surveyed by mail. On average, buprenorphine prescribers reported ambivalence regarding the impacts of the ACA, as indicated by a mean of 2.75 (SD = 0.69) on a scale that ranged from 1 ("strongly disagree") to 5 ("strongly agree"). A multi-level mixed-effects regression model indicated that physicians practicing in states that were supportive of ACA, as indicated by adopting both the Medicaid expansion and implementing a state-based health insurance exchange, had more positive perceptions of the ACA than physicians in states that had declined both of these policies. This study suggests that state approaches to ACA may be associated with varied impacts.
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Affiliation(s)
- Hannah K Knudsen
- a Associate Professor, Center on Drug and Alcohol Research , University of Kentucky , Lexington , KY , USA.,b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
| | - Jamie L Studts
- b Associate Professor, Department of Behavioral Science , University of Kentucky , Lexington , KY , USA
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23
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Vaeth PAC, Wang-Schweig M, Caetano R. Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups. Alcohol Clin Exp Res 2016; 41:6-19. [PMID: 28019654 DOI: 10.1111/acer.13285] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/31/2016] [Indexed: 01/07/2023]
Abstract
Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.
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Affiliation(s)
- Patrice A C Vaeth
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Meme Wang-Schweig
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California
| | - Raul Caetano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.,The University of Texas School of Public Health, Dallas, Texas
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24
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Martin JL, Burrow-Sánchez JJ, Iwamoto DK, Glidden-Tracey CE, Vaughan EL. Counseling Psychology and Substance Use. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000016667536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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25
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Andrews C, Grogan CM, Brennan M, Pollack HA. Lessons From Medicaid's Divergent Paths On Mental Health And Addiction Services. Health Aff (Millwood) 2016; 34:1131-8. [PMID: 26153307 DOI: 10.1377/hlthaff.2015.0151] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the past fifty years Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of funding and had a profound impact on the organization and delivery of services. But it played a much more modest role in addiction treatment. This is poised to change, as the Affordable Care Act is expected to dramatically expand Medicaid's role in financing addiction services. In this article we consider the different paths these two treatment systems have taken since 1965 and identify strategic lessons that the addiction treatment system might take from mental health's experience under Medicaid. These lessons include leveraging optional coverage categories to tailor Medicaid to the unique needs of the addiction treatment system, providing incentives to addiction treatment programs to create and deliver high-quality alternatives to inpatient treatment, and using targeted Medicaid licensure standards to increase the quality of addiction services.
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Affiliation(s)
- Christina Andrews
- Christina Andrews is an assistant professor in the College of Social Work, University of South Carolina, in Columbia
| | - Colleen M Grogan
- Colleen M. Grogan is a professor in the School of Social Service Administration, University of Chicago, in Illinois
| | - Marianne Brennan
- Marianne Brennan is a doctoral student in the School of Social Service Administration, University of Chicago
| | - Harold A Pollack
- Harold A. Pollack is a professor in the School of Social Service Administration, University of Chicago
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Kulesza M, Matsuda M, Ramirez JJ, Werntz AJ, Teachman BA, Lindgren KP. Towards greater understanding of addiction stigma: Intersectionality with race/ethnicity and gender. Drug Alcohol Depend 2016; 169:85-91. [PMID: 27792911 PMCID: PMC6040658 DOI: 10.1016/j.drugalcdep.2016.10.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/20/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND In spite of the significant burden associated with substance use disorders, especially among persons who inject drugs (PWIDs), most affected individuals do not engage with any type of formal or informal treatment. Addiction stigma, which is represented by negative social attitudes toward individuals who use alcohol and/or other drugs, is one of the barriers to care that is poorly understood. The current study: a) assessed implicit (indirect and difficult to consciously control) and explicit (consciously controlled) beliefs about PWIDs among visitors to a public web site; and b) experimentally investigated the effects of ethnicity/race and gender on those implicit and explicit beliefs. METHODS N=899 predominantly White (70%) and women (62%) were randomly assigned to one of six target PWIDs conditions: gender (man/woman) x race/ethnicity (White, Black, Latino/a). Participants completed an Implicit Association Test and explicit assessment of addiction stigma. RESULTS Participants implicitly associated PWIDs (especially Latino/a vs. White PWIDs) with deserving punishment as opposed to help (p=0.003, d=0.31), indicating presence of addiction stigma-related implicit beliefs. However, this bias was not evident on the explicit measure (p=0.89). Gender did not predict differential implicit or explicit addiction stigma (p=0.18). CONCLUSIONS Contrary to explicit egalitarian views towards PWIDs, participants' implicit beliefs were more in line with addiction stigma. If replicated and clearer ties to behavior are established, results suggest the potential importance of identifying conditions under which implicit bias might influence behavior (even despite explicit egalitarian views) and increase the likelihood of discrimination towards PWIDs.
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Affiliation(s)
| | - Mauri Matsuda
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Jason J Ramirez
- University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA.
| | - Alexandra J Werntz
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Bethany A Teachman
- University of Virginia, Department of Psychology, 102 Gilmer Hall, Charlottesville, VA, 22904, USA.
| | - Kristen P Lindgren
- University of Washington, Department of Psychiatry, 1100 NE 45th Street, Seattle, WA, 98105, USA.
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Padwa H, Urada D, Gauthier P, Rieckmann T, Hurley B, Crèvecouer-MacPhail D, Rawson RA. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach. J Subst Abuse Treat 2016; 69:9-18. [DOI: 10.1016/j.jsat.2016.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/29/2016] [Accepted: 06/27/2016] [Indexed: 11/29/2022]
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28
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Schultz NR, Martinez R, Cucciare MA, Timko C. Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives. Subst Use Misuse 2016; 51:1330-41. [PMID: 27245200 DOI: 10.3109/10826084.2016.1168446] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. OBJECTIVES The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. METHODS Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. RESULTS Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. CONCLUSIONS/IMPORTANCE To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.
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Affiliation(s)
- Nicole R Schultz
- a Department of Psychology , Auburn University , Auburn , Alabama , USA
| | - Rociel Martinez
- b Clinical Psychology Graduate Program , Pacific Graduate School of Psychology-Stanford University Consortium , Palo Alto , California , USA
| | - Michael A Cucciare
- c Center for Mental Healthcare and Outcomes Research , Central Arkansas Veterans Affairs Health Care System , North Little Rock , Arkansas , USA.,d VA South Central (VISN 16) Mental Illness Research , Central Arkansas Veterans Health Care System , North Little Rock , Arkansas , USA.,e Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Christine Timko
- a Department of Psychology , Auburn University , Auburn , Alabama , USA.,f Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
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Abstract
One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. "Better enforcement" of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured.
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Affiliation(s)
- Thomas G McGuire
- Thomas G. McGuire is a professor of health economics in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts, and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
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Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, 72205, USA. .,Veterans Affairs South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 72205, USA. .,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Christine Timko
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94304, USA
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Cucciare MA, Cheung RC, Rongey C. Treating substance use disorders in patients with hepatitis C. Addiction 2015; 110:1057-9. [PMID: 25816843 DOI: 10.1111/add.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA. .,Veterans Affairs South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA. .,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Ramsey C Cheung
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University, Stanford, CA, USA
| | - Catherine Rongey
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, 94121, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Andrews C, Abraham A, Grogan CM, Pollack HA, Bersamira C, Humphreys K, Friedmann P. Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform. Health Aff (Millwood) 2015; 34:828-35. [PMID: 25941285 PMCID: PMC4706741 DOI: 10.1377/hlthaff.2014.1330] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment.
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Affiliation(s)
- Christina Andrews
- Christina Andrews is an assistant professor of social work at the University of South Carolina, in Columbia
| | - Amanda Abraham
- Amanda Abraham is an assistant professor of health policy and management at the University of Georgia, in Athens
| | - Colleen M Grogan
- Colleen M. Grogan is a professor of health policy at the University of Chicago, in Illinois
| | - Harold A Pollack
- Harold A. Pollock is an associate professor of health policy at the University of Chicago
| | - Clifford Bersamira
- Clifford Bersamira is a doctoral student in social work at the University of Chicago
| | - Keith Humphreys
- Keith Humphreys is a professor of psychiatry and behavioral sciences at the Veterans Affairs and Stanford University Medical Centers, both in Stanford, California
| | - Peter Friedmann
- Peter Friedmann is a professor of medicine at the Providence Veteran Affairs Medical Center, the Rhode Island Hospital, and the Alpert Medical School of Brown University, all in Providence, Rhode Island
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