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Choi S, Hong S, Gatanaga OS, Yum AJ, Lim S, Neighbors CJ, Yi SS. Substance use and treatment disparities among Asian Americans, Native Hawaiians, and Pacific Islanders: A systematic review. Drug Alcohol Depend 2024; 256:111088. [PMID: 38262197 PMCID: PMC10922506 DOI: 10.1016/j.drugalcdep.2024.111088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/30/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The increasing relevance of substance use disorder (SUD) within the Asian American, Native Hawaiian, and Pacific Islander (AA&NH/PI) communities, particularly amidst rising anti-Asian hate incidents and the disproportionate health and economic challenges faced by the NH/PI community during the COVID-19 pandemic, underscores the urgency of understanding substance use patterns, treatment disparities, and outcomes. METHODS Following PRISMA guidelines, 37 out of 231 studies met the search criteria. Study characteristics, study datasets, substance use rates, SUD rates, treatment disparities, treatment quality, completion rates, and analyses disaggregated by the most specific AA&NH/PI ethnic group reported were examined. RESULTS Despite increased treatment admissions over the past two decades, AA&NH/PI remain underrepresented in treatment facilities and underutilize SUD care services. Treatment quality and completion rates are also lower among AA&NH/PI. Analyses that did not disaggregate AA and NHPI as distinct groups from each other or that presented aggregate data only within AA or NHPI as a whole were common, but available disaggregated analyses reveal variations in substance use and treatment disparities among ethnic groups. There is also a lack of research in exploring within-group disparities, including specific case of older adults and substance use. CONCLUSION To address disparities in access to substance use treatment and improve outcomes for AA&NH/PI populations, targeted interventions and strategic data collection methods that capture diverse ethnic groups and languages are crucial. Acknowledging data bias and expanding data collection to encompass multiple languages are essential for fostering a more inclusive approach to addressing SUD among AA&NH/PI populations.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America.
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America; New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Ohshue S Gatanaga
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Alexander J Yum
- University of Pennsylvania College of Arts and Sciences, Philadelphia, PA, United States of America
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
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D'Aunno T, Neighbors CJ. Innovation in the Delivery of Behavioral Health Services. Annu Rev Public Health 2023; 45. [PMID: 37871139 DOI: 10.1146/annurev-publhealth-071521-024027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Several factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Thomas D'Aunno
- Wagner Graduate School of Public Service, New York University, New York, NY, USA;
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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Choi S, Bunting A, Nadel T, Neighbors CJ, Oser CB. Organizational access points and substance use disorder treatment utilization among Black women: a longitudinal cohort study. Health Justice 2023; 11:31. [PMID: 37603194 PMCID: PMC10440874 DOI: 10.1186/s40352-023-00236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/14/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Health and social service organizations, including the emergency department (ED) and public assistance programs, constitute a social safety net that may serve as an "access point" for substance use treatment utilization. Racialization of substance use disorder (SUD) and gender disparities in access to treatment contribute to differences in health and social service utilization, including substance use treatment for Black women. We therefore explored the role of various access points in facilitating the use of substance use treatment among Black women with substance use and involvement in the criminal justice system. METHODS We used data from the Black Women in the Study of Epidemics (B-WISE) project (2008-2011), which recruited Black women who use drugs from community, probation, and prison recruitment settings in Kentucky. B-WISE is a three-wave panel survey collected on a six-month interval. We estimated dynamic panel models to understand whether time-varying use of services influenced women's substance use treatment utilization over 18-months, adjusting for time-invariant characteristics. We stratified the analysis based on where women were recruited (i.e., community, prison, and probation). RESULTS The sample included 310 persons and 930 person-waves. For the community and prison samples, the use of an ED in the 6 months prior decreased women's likelihood of subsequent substance use treatment use (Coef: -0.21 (95% CI: -0.40, -0.01); -0.33 (95% CI: -0.60, -0.06), respectively). For the probation sample, receiving support from public assistance (i.e., food stamps, housing, cash assistance) increased the likelihood of subsequent substance use treatment use (0.27 (95% CI: 0.08, 0.46)). CONCLUSION Interactions with health and social service organizations predicted Black women's use of substance use treatment services and varied based on their involvement in the criminal justice system. Public assistance venues for Black women on probation may be a point of intervention to increase their access to and use of substance use treatment.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Amanda Bunting
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Talia Nadel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
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Berry CA, Kwok L, Gofine M, Kaufman M, Williams DA, Terlizzi K, Alvaro M, Neighbors CJ. Utilization and Staff Perspectives on an On-Demand Telemedicine Model for People with Intellectual and Developmental Disabilities Who Reside in Certified Group Residences. Telemed Rep 2023; 4:204-214. [PMID: 37529771 PMCID: PMC10389255 DOI: 10.1089/tmr.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/03/2023]
Abstract
Background Non-emergent medical problems that arise when a usual provider is unavailable can often result in emergency department or urgent care visits, which can be particularly distressing to people with intellectual and developmental disabilities (PIDD). On-demand, synchronous telemedicine may be a promising supplement when immediate care from usual sources is unavailable. Prior research demonstrated that high-quality telemedicine can be effectively delivered to PIDD. The aim of this article is to describe the utilization and staff perspectives on the implementation of the Telemedicine Triage Project (TTP), an innovative model that provides telemedicine consultations for PIDD who reside in state-certified group residences and present with an urgent but non-emergent medical concern when their usual provider is unavailable. Methods Call frequency data for calendar years 2020 and 2021 were reviewed. The study team conducted semi-structured interviews, with 19 key informants representing organizational- and agency-level leadership and staff. The interview data were analyzed using a protocol-driven, rapid qualitative methodology. Results Telemedicine consultations increased from 7953 in 2020 to 15,011 calls in 2021, and call volume peaked between 10 am and 1 pm. Key informants reported high satisfaction with TTP; universal benefits and a few barriers to implementation; and strong interest in maintaining the program beyond the grant period. Discussion Over the first 2 years of its implementation, the TTP program was widely utilized and proved extremely feasible and acceptable to staff. This model is a promising and highly feasible way to provide equitable access to telemedicine for PIDD by addressing barriers to and disparities in access to health care that affect PIDD.
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Affiliation(s)
- Carolyn A. Berry
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorraine Kwok
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Miriam Gofine
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Debra A. Williams
- Cerebral Palsy Associations of New York State, Cohoes, New York, USA
| | - Kelly Terlizzi
- Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA
| | - Mike Alvaro
- Cerebral Palsy Associations of New York State, Cohoes, New York, USA
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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Napolitano MA, Bailey CP, Mavredes MN, Neighbors CJ, Whiteley JA, Long MW, Hayman LL, Malin SK, DiPietro L. Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis. Transl Behav Med 2023; 13:358-367. [PMID: 37186191 PMCID: PMC10255761 DOI: 10.1093/tbm/ibac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Caitlin P Bailey
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Meghan N Mavredes
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Jessica A Whiteley
- Departmen of Exercise and Health Sciences, College of Nursing and Health Sciences, The University of Massachusetts at Boston, Boston, MA, USA
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Laura L Hayman
- Department of Nursing, College of Nursing and Health Sciences, The University of Massachusetts at Boston, Boston, MA, USA
| | - Steven K Malin
- Department of Kinesiology and Division of Endocrinology, Metabolism and Nutrition, Rutgers University, New Brunswick, NJ, USA
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Neighbors CJ, Choi S, Yerneni R, Forthal S, Morgenstern J. Effects of Medicaid Health Homes among people with substance use disorder and another chronic condition on health care utilization and spending: Lessons from New York State. J Subst Abuse Treat 2022; 132:108503. [PMID: 34098212 PMCID: PMC8628019 DOI: 10.1016/j.jsat.2021.108503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD). METHODS Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost. RESULTS The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93). CONCLUSION These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD.
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Affiliation(s)
- Charles J Neighbors
- Partnership to End Addiction*, 711 Third Avenue, New York, NY 10017,New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016
| | - Sugy Choi
- Partnership to End Addiction*, 711 Third Avenue, New York, NY 10017,Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Rajeev Yerneni
- Partnership to End Addiction*, 711 Third Avenue, New York, NY 10017
| | - Sarah Forthal
- Partnership to End Addiction*, 711 Third Avenue, New York, NY 10017
| | - Jon Morgenstern
- Northwell Health, 1010 Northern Blvd, Suite 311 Great Neck, NY 11021
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O’Grady MA, Randrianarivony R, Martin K, Perez-Cubillan Y, Collymore DC, Shapiro-Luft D, Beacham A, Heyward N, Greenfield B, Neighbors CJ. Together in care: Lessons learned at the intersection of integrated care, quality improvement, and implementation practice in opioid treatment programs. Implementation Research and Practice 2022; 3:26334895221135265. [PMID: 37091088 PMCID: PMC9924288 DOI: 10.1177/26334895221135265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Integrated care programs that systematically and comprehensively address both behavioral and physical health may improve patient outcomes. However, there are few examples of such programs in addiction treatment settings. This article is a practical implementation report describing the implementation of an integrated care program into two opioid treatment programs (OTPs). Method Strategies used to implement integrated care into two OTPs included external facilitation, quality improvement (QI) processes, staff training, and an integrated organizational structure. Service, implementation, and client outcomes were examined using qualitative interviews with program staff (n = 16), program enrollment data, and client outcome data (n = 593) on mental health (MH), physical health, and functional indicators. Results Staff found the program to generally be acceptable and appropriate, but also noted that the new services added to already busy workflows and more staffing were needed to fully reach the program's potential. The program had a high level of penetration (∼60%–70%), enrolling over 1,200 clients. Staff noted difficulties in connecting clients with some services. Client general functioning and MH symptoms improved, and heavy smoking decreased. The organizational structure and QI activities provided a strong foundation for interactive problem-solving and adaptations that were needed during implementation. Conclusions This article highlights an example of the intersection of QI and implementation practice. Simplified QI processes, consistent post-implementation meetings, and change teams and champions facilitated implementation; however, ongoing training and support, especially related to data are needed. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff is necessary. Plain Language Summary: Providing medical and behavioral health treatment services in the same clinic using coordinated treatment teams, also known as integrated care, improves outcomes among those with chronic physical and behavioral health conditions. However, there are few practical examples of implementation of such programs in addiction treatment settings, which are promising, yet underutilized settings for integrated care programs. A multi-sectoral team used quality improvement (QI) and implementation strategies to implement integrated care into two opioid treatment programs (OTPs). The program enrolled over 1,200 clients and client general functioning and mental health (MH) symptoms improved, and heavy smoking decreased. Qualitative interviews provided important information about the barriers, facilitators, and context around implementation of this program. The OTP setting provided a strong foundation to build integrated care, but careful consideration of new workflows and changes in philosophy for staff, as well as ongoing training and supports for staff, are necessary. This project may help to advance the implementation of integrated care in OTPs by identifying barriers and facilitators to implementation, lessons learned, as well as providing a practical example of potentially useful QI and implementation strategies.
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Affiliation(s)
- Megan A. O’Grady
- Departmet of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | | | | | | | | | | | - Nyasia Heyward
- Bureau of Adult Treatment, New York State Office of Addiction Services and Supports, New York, USA
| | - Belinda Greenfield
- Bureau of Adult Treatment, New York State Office of Addiction Services and Supports, New York, USA
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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O'Grady MA, Neighbors CJ, Randrianarivony R, Shapiro-Luft D, Tempchin J, Perez-Cubillan Y, Collymore DC, Martin K, Heyward N, Wu M, Beacham A, Greenfield B. Identifying the Physical and Mental Healthcare Needs of Opioid Treatment Program Clients. Subst Use Misuse 2022; 57:1164-1169. [PMID: 35440294 DOI: 10.1080/10826084.2022.2064508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Individuals with opioid use disorder (OUD) often have significant medical and behavioral health needs that are unaddressed. Opioid treatment programs (OTP) are uniquely positioned to provide integrated services for OUD, physical and mental health but are underutilized for this purpose. This study aims to describe the physical and mental healthcare needs of OTP clients in order to inform integrated care implementation in OTPs. Method: OTP clients (n = 1261) in an integrated care program in the Bronx borough of New York City were assessed for mental health symptoms (e.g., anxiety, depression), chronic disease indicators (e.g., blood pressure, cholesterol), and general functioning (e.g., capability of managing healthcare needs). Results: Symptoms of anxiety, post-traumatic stress, and depression were common. Self-reported health status and level of functioning were generally poor. Heavy smoking and obesity were the most frequent physical health risks. Other chronic disease indicators (e.g., blood pressure) showed 25-46% may be at risk. Sixty percent had multiple mental health risks and 85% had multiple physical health risks. Older clients had a higher rate of hypertension and diabetes risk than younger clients. Conclusions: Integrated care programs in OTPs must be prepared to address and coordinate care for chronic mental and physical health conditions in addition to OUD.
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Affiliation(s)
- Megan A O'Grady
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Charles J Neighbors
- New York University Grossman School of Medicine, New York City, New York, USA
| | | | | | - Jacob Tempchin
- Partnership to End Addiction, New York City, New York, USA
| | | | | | | | - Nyasia Heyward
- New York State Office of Addiction Services and Supports, Albany, New York, USA
| | - Morgan Wu
- Partnership to End Addiction, New York City, New York, USA
| | - Alexa Beacham
- Partnership to End Addiction, New York City, New York, USA
| | - Belinda Greenfield
- New York State Office of Addiction Services and Supports, Albany, New York, USA
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Neighbors CJ, Hussain S, O'Grady M, Manseau M, Choi S, Hu X, Burke C, Lincourt P. Predictive validity of the New York State Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) for continuous engagement in treatment among individuals recommended for outpatient care. J Subst Abuse Treat 2021; 131:108559. [PMID: 34272131 DOI: 10.1016/j.jsat.2021.108559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/26/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The New York State (NYS) Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) was launched in 2015 to determine the most appropriate level of care for individuals seeking addiction treatment. However, research has not studied its predictive validity. We examined the predictive validity of the LOCADTR recommendation for outpatient treatment by determining whether those who entered a level of care (LOC) concordant with the LOCADTR recommendation differed in continuous engagement in treatment compared to those who entered a discordant LOC. METHODS The study combined data from two NYS administrative sources, the LOCADTR database and a treatment registry. The study examined characteristics of the clients who entered concordant and discordant LOCs as well as tested for differences in continuous engagement of clients who entered discordant care compared to a propensity score-matched comparison group of clients who entered the concordant LOC. RESULTS Among clients for whom the LOCADTR recommended the outpatient LOC, concordant clients who entered the outpatient LOC were more likely to be retained in care than discordant clients who entered the inpatient LOC (aOR = 0.53; 95% CI = 0.36, 0.77). We did not observe statistical differences in continuous engagement among clients who were recommended for outpatient and entered that LOC versus those who entered the outpatient rehabilitation LOC instead (aOR = 1.08; 95% CI = 0.90, 1.30). CONCLUSION This study provides support for predictive validity of recommendations stemming from the LOCADTR. Clients, treatment providers, and payers benefited from a tool that provides clear guidance and predictively valid recommendations for treatment placement. The study found that clients were more likely to be retained in treatment for 6 months or longer if admitted to outpatient care, as recommended by the LOCADTR algorithm, rather than to inpatient treatment. One factor accounting for the longer engagement in outpatient care is the low level of continuity of care among patients being discharged from inpatient treatment.
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Affiliation(s)
- Charles J Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Megan O'Grady
- Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Marc Manseau
- New York State Office of Addiction Services and Supports, Albany, NY, USA; Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Xiaojing Hu
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Pat Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
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O'Grady MA, Lincourt P, Greenfield B, Manseau MW, Hussain S, Genece KG, Neighbors CJ. A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol. Implement Sci 2021; 16:5. [PMID: 33413493 PMCID: PMC7789887 DOI: 10.1186/s13012-020-01076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder. Methods A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data. Discussion This study will provide the field with a strong test of a multicomponent intervention to improve providers’ capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system. Trial registration Trial #NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-2635, USA.
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, 1450 Western Ave., Albany, NY, 12203, USA
| | - Belinda Greenfield
- New York State Office of Addiction Services and Supports, 501 7th Ave., 8th Floor, New York, NY, 10018, USA
| | - Marc W Manseau
- New York State Office of Addiction Services and Supports, 501 7th Ave., 8th Floor, New York, NY, 10018, USA
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports, 1450 Western Ave., Albany, NY, 12203, USA
| | - Kamala Greene Genece
- Partnership to End Addiction, 485 Lexington Avenue, 3rd Floor, New York, NY, 10017-6706, USA
| | - Charles J Neighbors
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.,NYU Wagner Graduate School of Public Service, 295 Lafayette Street, New York, NY, 10012, USA
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13
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Choi S, Healy S, Shapoval L, Forthal S, Neighbors CJ. Hepatitis C Virus Screening among Medicaid-Insured Individuals with Opioid Use Disorder across Substance Use Disorder Treatment Settings. Subst Use Misuse 2021; 56:258-263. [PMID: 33345680 PMCID: PMC8262086 DOI: 10.1080/10826084.2020.1858106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Although the rapid increase in opioid use disorders (OUD) and concurrent increase in Hepatitis C virus (HCV) in the United States is well-documented, little is known about HCV testing among high-risk populations. We examine patterns of HCV testing across OUD treatment settings for individuals with OUD in New York. Methods: Using 2014 New York Medicaid claims data, we identified OUD diagnosis, OUD treatment (methadone, buprenorphine, naltrexone, other treatment (inpatient or outpatient non-medication-based psychosocial treatment, such as psychotherapy) and no treatment) utilization and HCV-testing status among beneficiaries. We performed multivariable logistic regression to identify factors associated with HCV screening across OUD treatment settings. Results: 79,764 individuals with OUD diagnoses were identified in 2014. The prevalence of HCV screening was 32.4%, 16.2%, 20.6%, 16.8%, and 18.1% for those receiving methadone, buprenorphine, naltrexone, other treatment, and no treatment, respectively. In the adjusted logistic regression, those receiving any OUD treatment had greater odds of being screened, with the highest odds among methadone clients. Conclusions: Engagement in medication for OUD is associated with increased HCV testing. Findings indicate the importance of access to medication-based treatment for OUD and a need to further improve HCV screening rates.
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Affiliation(s)
- Sugy Choi
- Department of Health Services Research, Center on Addiction, New York, NY, USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Shannon Healy
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Liudmila Shapoval
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Sarah Forthal
- Department of Health Services Research, Center on Addiction, New York, NY, USA
| | - Charles J Neighbors
- Department of Health Services Research, Center on Addiction, New York, NY, USA.,Health Evaluation and Analytics Lab, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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O'Grady MA, Lincourt P, Gilmer E, Kwan M, Burke C, Lisio C, Neighbors CJ. How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study. Subst Abuse 2020; 14:1178221820924026. [PMID: 32518481 PMCID: PMC7252360 DOI: 10.1177/1178221820924026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
Healthcare systems are implementing value-based payment (VBP) arrangements in efforts to incentivize cost-effective, high quality of care. These arrangements represent a major shift for substance use disorder (SUD) treatment providers who may need to make changes to their clinical and business operations to meet new demands for quality under value-based contracts. This qualitative study was conducted in the context of New York State's efforts to implement VBP among SUD treatment providers to understand their experiences, challenges, and needs. Five focus groups were conducted across the State with a total of 68 treatment professionals. Content analysis was conducted and five themes emerged. First, competing demands, limited workforce and technology infrastructure, and perceived lack of information were leading to overwhelmed administrators. Second, confusion and financial fear was being driven by the need for new clinical roles, business practices, and external partnerships. Third, providers were undertaking a number of measures to address workforce needs. Fourth, providers were building new business models and clinical practices. Fifth, providers desired more support and information. As VBP models are being adopted, healthcare systems should identify ways to mitigate challenges and support SUD treatment providers that may have limited resources to address complex workforce, client, and infrastructure needs.
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Affiliation(s)
- Megan A O'Grady
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Evan Gilmer
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Michael Kwan
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Carla Lisio
- Center on Addiction, Division of Health Services Research, NY, USA
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Choi S, Yerneni R, Healy S, Goyal M, Neighbors CJ. Predictors of Medication Utilization for Opioid Use Disorder Among Medicaid-Insured HIV Patients in New York. Am J Addict 2020; 29:151-154. [PMID: 31951083 DOI: 10.1111/ajad.12998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/22/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This paper investigates the prevalence and predictors for opioid use disorder (OUD) pharmacotherapy utilization for Medicaid-insured patients with human immunodeficiency virus (HIV) in New York. METHODS We identified patients with HIV and OUD in 2014 in the New York State Medicaid claims data (n = 5621). The claims were used to identify individual client medication for addiction treatment (MAT) utilization, demographic information, and other medical and psychiatric health conditions. The logistic regression analyses were performed to explore the potential predictors of MAT service utilization among people with HIV and OUD. RESULTS Of 5621 identified patients with HIV and OUD, 3647 (65%) received some type of MAT. Eighty-seven percent of treated patients received methadone while 10% received buprenorphine and 3% utilized both the therapies. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE A substantial number of patients with HIV and OUD did not receive MAT. Findings suggest that there are opportunities to improve OUD care for patients with HIV and OUD, particularly among the younger generation, blacks, individuals living outside of New York City, and among those with serious psychiatric conditions. This initial study suggests that an additional research is needed to better understand how the gap in care affects this population. (Am J Addict 2020;29:151-154).
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Affiliation(s)
- Sugy Choi
- Department of Health Services Research, Center on Addiction, New York, New York.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Rajeev Yerneni
- Department of Health Services Research, Center on Addiction, New York, New York
| | - Shannon Healy
- Department of Health Services Research, Center on Addiction, New York, New York
| | - Mona Goyal
- Department of Health Services Research, Center on Addiction, New York, New York
| | - Charles J Neighbors
- Department of Health Services Research, Center on Addiction, New York, New York
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16
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O'Grady MA, Lincourt P, Hussain S, Gilmer E, Neighbors CJ. An instrument for assessing progress in substance use disorder treatment: a pilot study of initial reliability and factor structure of the Treatment Progress Assessment-8. J Addict Dis 2019; 38:49-54. [PMID: 31870228 DOI: 10.1080/10550887.2019.1695512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
New instruments are needed to assist substance use disorder (SUD) clinics in monitoring client treatment progress. This paper describes the development of an 8-item monitoring tool and results from a pilot to understand the tool's structure and reliability. 393 clients completed the tool upon treatment entry. A factor analysis resulted in a 2-factor solution: SUD symptoms and treatment progress. Multiple regression analyses showed that clients in inpatient detoxification had lower scores than those in less intensive levels of care. Acceptable internal consistency reliability was found. This study shows promise for the tool and sets the stage for future validation work.
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Affiliation(s)
- Megan A O'Grady
- Division of Health Services Research, Center on Addiction, New York, USA
| | - Patricia Lincourt
- Addiction Treatment and Recovery, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Shazia Hussain
- Practice Innovation and Care Management, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Evan Gilmer
- Division of Health Services Research, Center on Addiction, New York, USA
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17
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Neighbors CJ, Choi S, Healy S, Yerneni R, Sun T, Shapoval L. Age related medication for addiction treatment (MAT) use for opioid use disorder among Medicaid-insured patients in New York. Subst Abuse Treat Prev Policy 2019; 14:28. [PMID: 31238952 PMCID: PMC6593566 DOI: 10.1186/s13011-019-0215-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023]
Abstract
Background Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. Methods Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. Results A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18–29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30–39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56–1.68), 40–49 year olds (AOR = 1.90, 95% CI = 1.82–1.99), 50–59 year olds (AOR = 2.65, 95% CI = 2.52–2.78), and 60–64 year olds (AOR = 5.03, 95% CI = 4.62–5.48) were more likely to receive MAT. Conclusions These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.
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Affiliation(s)
| | - Sugy Choi
- Center on Addiction, New York, NY, USA.,Boston University School of Public Health, Boston, MA, USA
| | | | | | - Tong Sun
- New York State Office of Alcoholism and Substance Abuse Services (OASAS), Albany, NY, USA
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18
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O'Grady MA, Kapoor S, Kwon N, Morley J, Auerbach M, Neighbors CJ, Conigliaro J, Morgenstern J. Substance use screening and brief intervention: Evaluation of patient and implementation differences between primary care and emergency department settings. J Eval Clin Pract 2019; 25:441-447. [PMID: 30426596 DOI: 10.1111/jep.13060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/06/2018] [Accepted: 10/05/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency. METHODS Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567). Patients with a positive screen were further assessed for psychosocial, health, and substance use problems (n = 1604). Differences in patient characteristics between primary care and emergency settings were examined using chi-square and t tests. Multilevel logistic regression was used to examine whether setting type predicted screening results. Site-level indicators of implementation success were calculated (percentage prescreens completed, percentage full screens completed, and percentage refused services) for all patient visits (n = 78 656). RESULTS As compared with primary care patients, emergency patients had more severe substance use patterns and screening scores, were more likely to use a variety of illicit drugs, and reported more psychosocial issues. In logistic regression models, setting type did not predict whether patients screened positive; however, it did predict screening into a higher vs lower risk category such that emergency patients were more likely to be in a higher risk category. Emergency settings had lower indicators of implementation success (eg, 14% lower prescreen completion rate) as compared with primary care settings on some implementation measures. CONCLUSIONS This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care.
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Affiliation(s)
- Megan A O'Grady
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA
| | - Sandeep Kapoor
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Nancy Kwon
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Jeanne Morley
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Mark Auerbach
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Charles J Neighbors
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA
| | - Joseph Conigliaro
- Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Jon Morgenstern
- Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA.,Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.,Medicine and Psychiatry, Hofstra Northwell School of Medicine, Hempstead, New York, USA
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Bachhuber MA, O'Grady MA, Chung H, Neighbors CJ, DeLuca J, D'Aloia EM, Diaz A, Cunningham CO. Delivery of screening and brief intervention for unhealthy alcohol use in an urban academic Federally Qualified Health Center. Addict Sci Clin Pract 2017; 12:33. [PMID: 29212532 PMCID: PMC5719726 DOI: 10.1186/s13722-017-0100-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background Screening and brief intervention (SBI) for unhealthy drinking has not been widely implemented in primary care partly due to reliance on physicians to perform it. Methods We implemented a model of nursing staff-delivered SBI for unhealthy drinking for adult patients receiving primary care at an academically-affiliated Federally Qualified Health Center in the Bronx, NY. Our model consisted of nursing staff screening all patients with the alcohol use disorders identification test consumption questions (AUDIT-C) and, if screening positive, providing BI or referral to specialty services. We developed a clinical decision support tool integrated into the electronic health record to guide nursing staff and record SBI provision. To evaluate this model, we determined overall SBI delivery to patients and factors associated with receiving SBI. Results Between October 2013 and September 2014, 9119 unique adult patients made 24,285 visits. Patients were majority women (67.5%) and Hispanic/Latino (54.5%). Overall, 46.2% were screened, with 19.0–35.8% of eligible patients screened in each month. Increasing age (OR: 0.82 [95% CI 0.80–0.85] for a 10-year increase), female sex (OR: 0.83 [95% CI 0.77–0.91]), and chronic conditions like hypertension (OR: 0.62 [95% CI 0.56–0.70]) and diabetes (OR: 0.66 [95% CI 0.58–0.75]), among others, were associated with a lower odds of being screened. Of all patients screened, 225 (5.3%) screened positive and of those patients, 122 (54.2%) received a BI. Patients with higher AUDIT-C scores were more likely to receive a BI (OR: 1.24 [95% CI 1.04–1.47] for a 1-point increase) and non-English speaking patients were less likely to receive a BI than those who spoke English (OR: 0.42 [95% CI 0.18–0.97]). Conclusions Our model of SBI resulted in screening of nearly half of all eligible patients and BI provision to over half of those screening positive. Future efforts to improve SBI delivery should focus on groups such as older adults, women, and those with chronic medical conditions.
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Affiliation(s)
- Marcus A Bachhuber
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA.
| | - Megan A O'Grady
- Department of Health and Treatment Research and Analysis, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, 19th Floor, New York, NY, 10017, USA
| | - Henry Chung
- Montefiore Care Management, Montefiore Medical Center, 200 Corporate Boulevard South, Yonkers, NY, 10701, USA
| | - Charles J Neighbors
- Department of Health and Treatment Research and Analysis, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, 19th Floor, New York, NY, 10017, USA
| | - Joseph DeLuca
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
| | - Elenita M D'Aloia
- Montefiore Medical Group, Montefiore Medical Center, 305 E 161st St, Bronx, NY, 10451, USA
| | - Arelis Diaz
- Montefiore Medical Group, Montefiore Medical Center, 305 E 161st St, Bronx, NY, 10451, USA
| | - Chinazo O Cunningham
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA
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Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Napolitano MA, Whiteley JA, Mavredes MN, Faro J, DiPietro L, Hayman LL, Neighbors CJ, Simmens S. Using social media to deliver weight loss programming to young adults: Design and rationale for the Healthy Body Healthy U (HBHU) trial. Contemp Clin Trials 2017; 60:1-13. [PMID: 28611007 DOI: 10.1016/j.cct.2017.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/18/2017] [Accepted: 06/09/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The transitional period from late adolescence to early adulthood is a vulnerable period for weight gain, with a twofold increase in overweight/obesity during this life transition. In the United States, approximately one-third of young adults have obesity and are at a high risk for weight gain. PURPOSE To describe the design and rationale of a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored randomized, controlled clinical trial, the Healthy Body Healthy U (HBHU) study, which compares the differential efficacy of three interventions on weight loss among young adults aged 18-35years. METHODS The intervention is delivered via Facebook and SMS Text Messaging (text messaging) and includes: 1) targeted content (Targeted); 2) tailored or personalized feedback (Tailored); or 3) contact control (Control). Recruitment is on-going at two campus sites, with the intervention delivery conducted by the parent site. A total of 450 students will be randomly-assigned to receive one of three programs for 18months. We hypothesize that: a) the Tailored group will lose significantly more weight at the 6, 12, 18month follow-ups compared with the Targeted group; and that b) both the Tailored and Targeted groups will have greater weight loss at the 6, 12, 18month follow-ups than the Control group. We also hypothesize that participants who achieve a 5% weight loss at 6 and 18months will have greater improvements in their cardiometabolic risk factors than those who do not achieve this target. We will examine intervention costs to inform implementation and sustainability other universities. Expected study completion date is 2019. CONCLUSIONS This project has significant public health impact, as the successful translation could reach as many as 20 million university students each year, and change the current standard of practice for promoting weight management within university campus communities. ClinicalTrial.gov: NCT02342912.
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Affiliation(s)
- Melissa A Napolitano
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 300, Washington, DC 20052, USA; Department of Exercise and Nutrition Sciences, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 200, Washington, DC 20052, USA.
| | - Jessica A Whiteley
- College of Nursing and Health Sciences, University of Massachusetts Boston, Exercise and Health Sciences Program, 100 Morrissey Blvd, Science Center, 2(nd) Floor, Boston, MA 02125-3393, USA.
| | - Meghan N Mavredes
- Department of Prevention and Community Health, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 300, Washington, DC 20052, USA.
| | - Jamie Faro
- College of Nursing and Health Sciences, University of Massachusetts Boston, Exercise and Health Sciences Program, 100 Morrissey Blvd, Science Center, 2(nd) Floor, Boston, MA 02125-3393, USA.
| | - Loretta DiPietro
- Department of Exercise and Nutrition Sciences, The George Washington University, Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 200, Washington, DC 20052, USA.
| | - Laura L Hayman
- University of Massachusetts Boston, Department of Nursing, 100 Morrissey Blvd, Quinn Administration-01-01, Boston, MA 02125-3393, USA.
| | - Charles J Neighbors
- Columbia University, The National Center on Addiction and Substance Abuse, Health Services Research, 633 Third Avenue, 19th Floor, New York, NY 10017, USA.
| | - Samuel Simmens
- The George Washington University, Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Science & Engineering Hall, 800 22nd St NW, Floor 7, Washington, DC 20052, USA.
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Hall G, Neighbors CJ, Iheoma J, Dauber S, Adams M, Culleton R, Muench F, Borys S, McDonald R, Morgenstern J. Mobile opioid agonist treatment and public funding expands treatment for disenfranchised opioid-dependent individuals. J Subst Abuse Treat 2013; 46:511-5. [PMID: 24468235 DOI: 10.1016/j.jsat.2013.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/17/2013] [Accepted: 11/12/2013] [Indexed: 11/27/2022]
Abstract
The New Jersey Medication Assisted Treatment Initiative (NJ-MATI) sought to reduce barriers to treatment by providing free, opioid agonist treatment (OAT, methadone or buprenorphine) via mobile medication units (MMUs). To evaluate barriers to OAT, logistic regression was used to compare opioid dependent patients enrolled in NJ-MATI to those entering treatment at fixed-site methadone clinics or non-medication assisted treatment (non-MAT). Client demographic and clinical data were taken from an administrative database for licensed treatment providers. The MMUs enrolled a greater proportion of African-American, homeless, and uninsured individuals than the fixed-site methadone clinics. Compared to non-MAT and traditional methadone clients, NJ-MATI patients were more likely to be injection drug users and daily users but less likely to have a recent history of treatment. These observations suggest that the patient-centered policies associated with NJ-MATI increased treatment participation by high severity, socially disenfranchised patients who were not likely to receive OAT.
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Affiliation(s)
- Gerod Hall
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA
| | - Charles J Neighbors
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA.
| | - Jude Iheoma
- State of New Jersey - Department of Human Services, Division of Mental Health and Addiction Services (DMHAS), 222S. Warren Street, 4th Floor, Trenton, NJ 08625, USA
| | - Sarah Dauber
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA
| | - Merribeth Adams
- The National Council on Alcoholism and Drug Dependence - New Jersey, 360 Corporate Boulevard, Robbinsville, NJ 08691, USA
| | - Robert Culleton
- State of New Jersey - Department of Human Services, Division of Mental Health and Addiction Services (DMHAS), 222S. Warren Street, 4th Floor, Trenton, NJ 08625, USA
| | - Fred Muench
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA
| | - Suzanne Borys
- State of New Jersey - Department of Human Services, Division of Mental Health and Addiction Services (DMHAS), 222S. Warren Street, 4th Floor, Trenton, NJ 08625, USA
| | - Rebecca McDonald
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA
| | - Jon Morgenstern
- The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA
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Chung H, Kim A, Neighbors CJ, Cummings J, Ricketts S, O'Grady MA, Raum D. Early experience of a pilot intervention for patients with depression and chronic medical illness in an urban ACO. Gen Hosp Psychiatry 2013; 35:468-71. [PMID: 23759254 DOI: 10.1016/j.genhosppsych.2013.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/26/2013] [Accepted: 04/30/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective was to describe the design, implementation and preliminary results of a collaborative care pilot program using hybrid colocation and centralized care management for patients with depression and chronic medical illness in an urban accountable care organization. METHODS Patients with chronic illness (diabetes mellitus, coronary artery disease and/or congestive heart failure) and comorbid depressive symptoms (Patient Health Questionnaire [PHQ]9 score ≥10) were enrolled. The interventions included collaborative care for depression and chronic conditions; behavioral support, including short-term psychotherapy by licensed clinical social worker on-site or telephonically; off-site nurse care management and psychiatrist consultation through an electronic medical record. RESULTS Forty-four percent of patients (n=61) achieved a depression response. In a diabetes subgroup with depression and glycosylated hemoglobin level HbA1c >8 (n=21), 33% had a depression response with a minimum 0.5% HbA1c reduction. Among a subgroup (n=25) with Framingham risk score >15% and depression, mean PHQ9 depression scores and mean Framingham scores were reduced by 35% and 34%, respectively. CONCLUSIONS Early experience of the pilot for multiple chronic illnesses and depression appears feasible and shows initial promise.
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Affiliation(s)
- Henry Chung
- Montefiore Care Management, Montefiore Medical Center, Bronx, NY, USA.
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Neighbors CJ, Sun Y, Yerneni R, Tesiny E, Burke C, Bardsley L, McDonald R, Morgenstern J. Medicaid care management: description of high-cost addictions treatment clients. J Subst Abuse Treat 2013; 45:280-6. [PMID: 23579079 DOI: 10.1016/j.jsat.2013.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/16/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022]
Abstract
High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals.
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Affiliation(s)
- Charles J Neighbors
- Health and Treatment Research and Analysis Division, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA.
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Kuerbis AN, Neighbors CJ, Morgenstern J. Depression's moderation of the effectiveness of intensive case management with substance-dependent women on temporary assistance for needy families: outpatient substance use disorder treatment utilization and outcomes. J Stud Alcohol Drugs 2011; 72:297-307. [PMID: 21388603 DOI: 10.15288/jsad.2011.72.297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators. METHOD Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months. RESULTS Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent. CONCLUSIONS ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.
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Affiliation(s)
- Alexis N Kuerbis
- Research Foundation for Mental Hygiene, Inc., Columbia Addiction Services and Psychotherapy Interventions Research, Columbia University, 3 Columbus Circle, New York, NY 10019, USA.
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Hartman SJ, Dunsiger SI, Pekmezi DW, Barbera B, Neighbors CJ, Marquez B, Marcus BH. Impact of Baseline BMI upon the Success of Latina Participants Enrolled in a 6-Month Physical Activity Intervention. J Obes 2011; 2011:921916. [PMID: 22175003 PMCID: PMC3228324 DOI: 10.1155/2011/921916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/21/2011] [Accepted: 10/11/2011] [Indexed: 11/19/2022] Open
Abstract
High rates of obesity in Latinas highlight the need to determine if physical activity interventions are equally effective across the body mass index (BMI) range. Thus, this study assessed how BMI impacts success of Spanish-speaking Latinas in a culturally and linguistically adapted theory-based physical activity intervention (N = 45). Longitudinal regression models tested the relationship between baseline BMI and outcomes. Overall, a trend for a negative association was found between baseline BMI and self-reported physical activity and theoretical constructs targeted by the intervention over time. For example, someone with a 25 kg/m(2) BMI would report, on average, 27.5 more minutes/week of activity compared to someone with a 30 kg/m(2) BMI at followup. Furthermore, higher baseline BMI was significantly associated with lower self-efficacy, behavioral and cognitive processes of change, and family social support over time. These findings suggest that participants with higher BMI may need additional intervention to promote physical activity.
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Affiliation(s)
- Sheri J. Hartman
- Department of Family and Preventive Medicine, University of California, San Diego, 3855 Health Sciences Drive No. 0901, La Jolla, CA 92093-0901, USA
- *Sheri J. Hartman:
| | - Shira I. Dunsiger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Dori W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Brimingham, AL 35293, USA
| | - Brooke Barbera
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Charles J. Neighbors
- The National Center on Addiction and Substance Abuse, Columbia University, New York, NY 10017, USA
| | - Becky Marquez
- Department of Family and Preventive Medicine, University of California, San Diego, 3855 Health Sciences Drive No. 0901, La Jolla, CA 92093-0901, USA
| | - Bess H. Marcus
- Department of Family and Preventive Medicine, University of California, San Diego, 3855 Health Sciences Drive No. 0901, La Jolla, CA 92093-0901, USA
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Abstract
PURPOSE One of the factors distinguishing non-Latino blacks (NLB) and Latinos from non-Latino whites (NLW) is higher rates of occupational physical activity (OPA) and less participation in leisure time physical activity (LTPA). We examined participation in OPA and LTPA among employed individuals and the relationship between OPA and LTPA across select racial or ethnic groups and Latino subgroups. METHODS We pooled data from 2000 to 2003 of the National Health Interview Survey. We divided the survey participants into three groups: 1) those with no LTPA, 2) those who reported some LTPA but not for sufficient time and intensity to meet recommended guidelines, and 3) those who reported LTPA at levels that met or exceeded recommendations. We used ordinal logistic regression to examine whether NLB and Latinos or Latino subgroups were less likely to report LTPA than NLW while controlling for social, economic, and demographic factors that may have accounted for group differences. We further examined the prevalence of OPA and the relationship between LTPA and OPA. RESULTS Among employed individuals, NLB and Latinos had significantly more individuals reporting no LTPA compared with NLW. Latinos had the greatest proportion of individuals reporting no LTPA. Furthermore, it was found that significantly more Latinos had physically active occupations compared with NLB and NLB compared with NLW, respectively. Among employed Latinos, Cubans and Dominicans were most likely to report no LTPA, and Mexicans had the greatest percentage of workers with a physically active occupation. LTPA was not significantly associated with having a physically active occupation across races and Latino subgroups. CONCLUSIONS Participation in LTPA among ethnic or racial minorities is lower than that of NLW, and the OPA rates are higher. OPA does not significantly impact participation in LTPA in employed adults.
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Affiliation(s)
- David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, IL 60612, USA.
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Neighbors CJ, Barnett NP, Rohsenow DJ, Colby SM, Monti PM. Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department. J Stud Alcohol Drugs 2010; 71:384-94. [PMID: 20409432 PMCID: PMC2859787 DOI: 10.15288/jsad.2010.71.384] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Revised: 08/20/2009] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury. This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained. METHOD Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases. RESULTS Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates. CONCLUSIONS This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.
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Affiliation(s)
- Charles J. Neighbors
- The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York New York l0017
| | - Nancy P. Barnett
- The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York New York l0017
| | - Damaris J. Rohsenow
- The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York New York l0017
| | - Suzanne M. Colby
- The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York New York l0017
| | - Peter M. Monti
- The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 633 Third Avenue, 19th Floor, New York New York l0017
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Lewis BA, Williams DM, Neighbors CJ, Jakicic JM, Marcus BH. Cost Analysis of Internet vs. Print Interventions for Physical Activity Promotion. Psychol Sport Exerc 2010; 11:246-249. [PMID: 20401164 PMCID: PMC2853814 DOI: 10.1016/j.psychsport.2009.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE: The objective of this study was to compare the costs associated with Internet and print-based physical activity interventions. METHOD: The costs associated with delivering tailored print and Internet-based interventions were estimated from a randomized controlled physical activity trial (n=167). The estimates were based on research assistant time sampling surveys, web development invoices, and other tracking procedures. RESULTS: Web-development costs for the Internet intervention were $109,564. Taken together with the website hosting fees and staff costs, the cost per participant per month was $122.52 The cost of the print intervention was $35.81 per participant per month. However, in a break-even analysis, the Internet intervention became more cost-efficient, relative to the print intervention, when the total number of participants exceeded 352. CONCLUSIONS: Relative to print-based interventions, Internet-based interventions may be a more cost efficient way to reach a large number of sedentary individuals.
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Affiliation(s)
- Beth A Lewis
- University of Minnesota, School of Kinesiology, 209 Cooke Hall, 1900 University Avenue SE, Minneapolis, MN 55455, USA
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Pekmezi DW, Neighbors CJ, Lee CS, Gans KM, Bock BC, Morrow KM, Marquez B, Dunsiger S, Marcus BH. A culturally adapted physical activity intervention for Latinas: a randomized controlled trial. Am J Prev Med 2009; 37:495-500. [PMID: 19944914 PMCID: PMC2814545 DOI: 10.1016/j.amepre.2009.08.023] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/24/2009] [Accepted: 08/01/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program. DESIGN An RCT was conducted. SETTING/PARTICIPANTS The sample included 93 overweight/obese (80%) Latinas with low income and acculturation. INTERVENTION Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition. MAIN OUTCOME MEASURES Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall. RESULTS Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants. CONCLUSIONS Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health. TRIAL REGISTRATION NCT00724165.
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Affiliation(s)
- Dorothy W Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35293, USA.
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Zywiak WH, Neighbors CJ, Martin RA, Johnson JE, Eaton CA, Rohsenow DJ. The Important People Drug and Alcohol interview: psychometric properties, predictive validity, and implications for treatment. J Subst Abuse Treat 2009; 36:321-30. [PMID: 18835677 PMCID: PMC2774263 DOI: 10.1016/j.jsat.2008.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 07/18/2008] [Accepted: 08/10/2008] [Indexed: 11/25/2022]
Abstract
Research with the Important People instrument has shown that social support for abstinence is related to alcohol treatment outcomes, but less work has been done on the role of network support in drug treatment outcomes. A drug and alcohol version of the Important People instrument (IPDA) was developed and administered to 141 patients in residential treatment for cocaine dependence. Three components were found, all with acceptable internal consistency: (a) substance involvement of the network, (b) general/treatment support, and (c) support for abstinence. These components and three fundamental network characteristics (size of daily network, size of network, and importance of the most important people) were investigated as correlates of pretreatment and posttreatment alcohol and drug use. The general/treatment support component and network size were inversely related to pretreatment days using drugs, whereas network substance involvement positively correlated with pretreatment drinking frequency. Size of the daily network predicted less drinking, less drug use, and less problem severity during the 6 months after treatment, whereas general/treatment support and support for abstinence did not predict outcome. Network substance involvement decreased for patients who stayed abstinent but not for those who later relapsed. Results suggest that increasing the number of people the patient sees daily while replacing substance-involved with abstinent-supportive people may improve treatment outcomes. Treatment programs may use the IPDA to identify clients most likely to benefit from changes in their social networks.
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Affiliation(s)
- William H Zywiak
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, Providence, RI 02906, USA.
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Morgenstern J, Neighbors CJ, Kuerbis A, Riordan A, Blanchard KA, McVeigh KH, Morgan TJ, McCrady B. Improving 24-month abstinence and employment outcomes for substance-dependent women receiving temporary assistance for needy families with intensive case management. Am J Public Health 2008; 99:328-33. [PMID: 19059855 DOI: 10.2105/ajph.2007.133553] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We examined abstinence rates among substance-dependent women receiving Temporary Assistance for Needy Families (TANF) in intensive case management (ICM) over 24 months and whether ICM yielded significantly better employment outcomes compared with a screen-and-refer program (i.e., usual care). METHODS Substance-dependent (n = 302) and non-substance dependent (n = 150) TANF applicants in Essex County, New Jersey, were recruited. We randomly assigned substance-dependent women to ICM or usual care. We interviewed all women at 3, 9, 15, and 24 months. RESULTS Abstinence rates were higher for the ICM group than for the usual care group through 24 months of follow-up (odds ratio [OR] = 2.11; 95% confidence interval [CI] = 1.36, 3.29). A statistically significant interaction between time and group on number of days employed indicated that the rate of improvement over time in employment was greater for the ICM group than for the usual care group (incidence rate ratio = 1.03; 95% CI = 1.02, 1.04). Additionally, there were greater odds of being employed full time for those in the ICM group (OR = 1.68; 95% CI = 1.12, 2.51). CONCLUSIONS ICM is a promising intervention for managing substance dependence among women receiving TANF and for improving employment rates among this vulnerable population.
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Affiliation(s)
- Jon Morgenstern
- National Center on Addiction and Substance Abuse, Columbia University, New York, NY 10017, USA.
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Graham AL, Papandonatos GD, DePue JD, Pinto BM, Borrelli B, Neighbors CJ, Niaura R, Buka SL, Abrams DB. Lifetime characteristics of participants and non-participants in a smoking cessation trial: implications for external validity and public health impact. Ann Behav Med 2008; 35:295-307. [PMID: 18414962 DOI: 10.1007/s12160-008-9031-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Detailed information about the characteristics of smokers who do and do not participate in smoking cessation treatment is needed to improve efforts to reach, motivate, and treat smokers. PURPOSE The aim of this study is to explore a broad range of characteristics related to participation in a smoking cessation trial. METHODS Eligible smokers were recruited from a longitudinal birth cohort. Participants and non-participants were compared on a broad range of sociodemographics, smoking, psychiatric and substance abuse disorders, personality, and prospective measures from early childhood. Eligible smokers were compared to a matched regional subsample of the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS Few differences were observed, most of which were statistically significant but not clinically meaningful. Compared to non-participants, participants were more likely to be single, have lower income, be more nicotine-dependent, be more motivated to quit, and have higher levels of depressed mood and stress even after covariance of gender, income, and marital status. Sociodemographic differences between participants and the BRFSS sample reflect the skew toward lower socioeconomic status in the original birth cohort. CONCLUSIONS The encouraging conclusion is that smokers who enroll in cessation trials may not differ much from non-participants. Information about treatment participants can inform the development of recruitment strategies, improve the tailoring of treatment to individual smoker profiles, help to estimate potential selection bias, and improve estimates of population impact.
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Affiliation(s)
- A L Graham
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA.
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Clark MA, Neighbors CJ, Wasserman MR, Armstrong GF, Drnach ML, Howie SL, Hawthorne TL. Strategies and cost of recruitment of middle-aged and older unmarried women in a cancer screening study. Cancer Epidemiol Biomarkers Prev 2008; 16:2605-14. [PMID: 18086764 DOI: 10.1158/1055-9965.epi-07-0157] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared strategies and costs associated with recruiting unmarried middle-aged and older women who partner with women (WPW) and women who partner with men (WPM) into an observational study about experiences with cancer screening. METHODS We used targeted and respondent-driven sampling methods to recruit potential participants. Comparable recruitment strategies were used for WPW and WPM. RESULTS During 25 months (June 1, 2003, through June 30, 2005), 773 women were screened for study eligibility; 630 were enrolled (213 WPW, 417 WPM). Average staff time spent for recruitment was 100 min per participant. There were no differences by partner gender in average recruitment time (WPW, 90 min; WPM, 100 min). Print media was the most efficient recruitment mode (time per participant: 10 min for WPW, 15 min for WPM). Recruitment costs differed by partner gender ($140 for WPW, $110 for WPM). Costs associated with print media were $10 per WPW and $20 per WPM. Recruitment through community events had higher costs ($490 per WPW, $275 per WPM) but yielded more women with less education and lower incomes, who identified as a racial or ethnic minority, and self-reported a disability. Compared with WPM, WPW had more education and higher incomes, but were less likely to identify as a racial minority and self-report a disability. CONCLUSIONS There was a trade-off between cost and sample diversity for the different recruitment methods. The per-person costs were lowest for print media, but recruitment through community events ensured a more diverse representation of unmarried heterosexual and sexual minority women.
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Affiliation(s)
- Melissa A Clark
- Center for Gerontology and Health Care Research, Brown University Medical School and Program in Public Health, Box G-S121, 6th Floor, Providence, RI 02903, USA.
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Abstract
Studies of leisure-time physical activity disparities for Hispanic individuals have not adjusted for sociodemographic confounds or accounted for variation by country of origin. We used the National Health Interview Survey to compare leisure-time physical activity among Hispanic and non-Hispanic White persons. All Hispanic subgroups were less active than were non-Hispanic White people, yet significant heterogeneity existed among Hispanic persons. Sociodemographic factors partly accounted for disparities among men; disparities among women persisted despite multivariate adjustments. Interventions must attend to these under-served yet varied sub-communities.
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Affiliation(s)
- Charles J Neighbors
- The National Center on Addiction and Substance Abuse, 633 Third Ave, New York, NY 10017, USA.
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Neighbors CJ, Rogers ML, Shenassa ED, Sciamanna CN, Clark MA, Novak SP. Ethnic/Racial Disparities in Hospital Procedure Volume for Lung Resection for Lung Cancer. Med Care 2007; 45:655-63. [PMID: 17571014 DOI: 10.1097/mlr.0b013e3180326110] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. OBJECTIVES We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. METHODS Six years of data from the Nationwide Inpatient Sample (NIS 1998-2003, unweighted n = 50,245, weighted n = 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. RESULTS Blacks/African Americans (odds ratio [OR] = 0.45; 0.34-0.58) and Latinos (OR = 0.44; 0.32-0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR = 1.30; 1.01-1.67), Latinos (OR = 1.41; 1.02-1.94), and other racial/ethnic minorities (OR = 1.46; 1.04-2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. CONCLUSIONS Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.
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Affiliation(s)
- Charles J Neighbors
- National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA.
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Neighbors CJ, Zywiak WH, Stout RL, Hoffmann NG. Psychobehavioral risk factors, substance treatment engagement and clinical outcomes as predictors of emergency department use and medical hospitalization. ACTA ACUST UNITED AC 2005; 66:295-304. [PMID: 15957682 DOI: 10.15288/jsa.2005.66.295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prior research on health care utilization after treatment for substance misuse disorders has not accounted for posttreatment clinical outcomes as well as putative confounds associated with both substance use and health care. This study examined the association of posttreatment health care utilization with treatment factors (program type and time in treatment) and baseline psychological/behavioral risk factors (smoking status and level of depressive, alcohol and drug dependence symptoms). The study also examined whether posttreatment clinical outcomes-participation in aftercare, Alcoholic Anonymous (AA) attendance, substance use, depressive symptoms and smoking- were associated with subsequent health care utilization. METHOD We analyzed predictors of posttreatment medical hospitalizations and emergency department (ED) use among 15,041 participants in a multistate treatment evaluation project conducted from 1987 to 1995. RESULTS Greater time in treatment reduced the likelihood of future hospitalizations and ED use, whereas clients in outpatient treatment were less likely to be hospitalized. Baseline measures of depressive, alcohol and drug dependence symptoms were each independently associated with subsequent health care use. Posttreatment aftercare participation reduced the likelihood of future hospitalization and ED use, whereas AA attendance also reduced the likelihood of hospitalization. In addition, posttreatment counts of depressive symptoms increased the likelihood of future hospitalization and ED use. Substance relapse increased the likelihood of subsequent ED use. CONCLUSIONS The study supports the public health importance of substance misuse disorders treatment, with greater treatment involvement associated with lower high-cost medical utilization. Treatment clinical outcomes-posttreatment relapse and depressive symptoms-partially mediate the effect of treatment on health care utilization.
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Affiliation(s)
- Charles J Neighbors
- Centers for Behavioral and Preventive Medicine, Coro Building, Suite 500, One Hoppin Street, Providence, RI 02903, USA.
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Bock BC, Niaura RS, Neighbors CJ, Carmona-Barros R, Azam M. Differences between Latino and non-Latino White smokers in cognitive and behavioral characteristics relevant to smoking cessation. Addict Behav 2005; 30:711-24. [PMID: 15833576 DOI: 10.1016/j.addbeh.2004.08.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adult smokers were recruited during routine health care visits at primary care clinics located in three urban hospitals and were given a brief intervention and nicotine replacement therapy. Analyses compared bicultural (BC: n=60) or less acculturated (LA: n=138) Latinos and non-Latino White (NL: n=417) participants. Both Latino groups were significantly different from NL subjects in smoking rate and nicotine dependence. However, BC and NL subjects differed significantly from LA subjects in perceived benefits of quitting, perceived risk from smoking, and negative affect smoking. LA subjects had higher cessation rates than either BC or NL groups. Regression analyses showed that nicotine dependence and confidence in quitting predicted cessation at month 6, and acculturation appeared to moderate the relationship between smoking cessation and both confidence in quitting and nicotine dependence. These results provide support for the viability of brief interventions for smoking provided through health care delivery systems. Results also suggest that characteristics previously shown to be predictive of successful cessation in mixed or non-Latino populations may not be equally predictive of cessation across members of diverse populations.
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Affiliation(s)
- Beth C Bock
- Centers for Behavioral and Preventive Medicine, Brown University Medical School, Providence, RI 02903, United States.
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Neighbors CJ, O'Leary A. Responses of male inmates to primary partner requests for condom use: effects of message content and domestic violence history. AIDS Educ Prev 2003; 15:93-108. [PMID: 12627746 DOI: 10.1521/aeap.15.1.93.23841] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many women at high risk for HIV infection face resistance and, in some cases, violence as a response to their requests for condom use. The current study investigated how domestically violent and nonviolent men reacted to various condom negotiation approaches. Ten different scenarios, in which the partner provides a justification for a condom request or the context suggests one, were presented to 84 male inmates selected at random from a county jail. As predicted, condom scenarios factored into groupings with content suggestive of high and low relationship threat. Of the justifications presented, yeast infections generated more favorable responses than standard HIV prevention messages. The riskiest condom negotiation scenario was one that suggested infidelity on the part of the woman. Level of male violence severity in the relationship predicted more coercive responses to suggestions of a woman's infidelity. The results suggest that creative strategies that do not call into question the fidelity or commitment of either partner may be more effective in getting men to use condoms and/or to not react violently.
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Neighbors CJ, O'Leary A, Labouvie E. Domestically violent and nonviolent male inmates' responses to their partners' requests for condom use: testing a social-information processing model. Health Psychol 1999. [PMID: 10431946 DOI: 10.1037//0278-6133.18.4.427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.
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Affiliation(s)
- C J Neighbors
- Psychology Department, Rutgers, The State University of New Jersey, USA.
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Neighbors CJ, O'Leary A, Labouvie E. Domestically violent and nonviolent male inmates' responses to their partners' requests for condom use: testing a social-information processing model. Health Psychol 1999; 18:427-31. [PMID: 10431946 DOI: 10.1037/0278-6133.18.4.427] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.
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Affiliation(s)
- C J Neighbors
- Psychology Department, Rutgers, The State University of New Jersey, USA.
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Morgenstern J, Frey RM, McCrady BS, Labouvie E, Neighbors CJ. Examining mediators of change in traditional chemical dependency treatment. J Stud Alcohol 1996; 57:53-64. [PMID: 8747502 DOI: 10.15288/jsa.1996.57.53] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Few studies have examined processes that mediate positive outcomes in the treatment of substance use disorders. The present study used a theory-driven approach to assess mechanisms hypothesized as curative by the traditional chemical dependency treatment approach. Several specific disease model processes such as accepting powerlessness over alcohol and two processes common to both the disease model and other treatment approaches (commitment to abstinence and intention to avoid high-risk situations) were studied. It was hypothesized that patients entering treatment would manifest high levels of denial, that there would be significant reduction of denial and increased endorsement of disease model and common processes as a result of treatment and that processes would mediate outcome. METHOD Patients (N = 79; 54 men) in intensive traditional alcohol/drug treatment were assessed at entry into treatment, at the end of treatment and 1 month following treatment. Both self-report and clinician ratings of processes were assessed. RESULTS Overall, results provided little support for study hypothesis. Subjects showed low levels of denial at treatment entry. Specific disease model, but not common processes, increased during treatment. Common processes, but not disease model processes, predicted relapse. Patients with higher levels of commitment to abstinence and greater intentions to avoid high-risk situations were at lower risk for relapse. However, greater commitment to Alcoholics Anonymous and belief in a Higher Power predicted reduced severity of relapse among those who did relapse. CONCLUSIONS Findings do not support prevailing practitioner views regarding how traditional treatment works and suggest that interventions in these treatments may be mismatched to patient needs.
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Affiliation(s)
- J Morgenstern
- Center of Alcohol Studies, Rutgers University, Piscataway, New Jersey 08855, USA
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