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Tong ST, Zheng Z, Prado MG, West II, LeMaster JW, Hatch MA, Szabo LS, Anastas TM, Ma KPK, Stephens KA. The Impact of the COVID-19 Pandemic on Patient Disparities in Long-Term Opioid Therapy. J Am Board Fam Med 2024; 37:290-294. [PMID: 38740467 DOI: 10.3122/jabfm.2023.230359r1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted how primary care patients with chronic pain received care. Our study sought to understand how long-term opioid therapy (LtOT) for chronic pain changed over the course of the pandemic overall and for different demographic subgroups. METHODS We used data from electronic health records of 64 primary care clinics across Washington state and Idaho to identify patients who had a chronic pain diagnosis and were receiving long-term opioid therapy. We defined 10-month periods in 2019 to 2021 as prepandemic, early pandemic and late pandemic and used generalized estimating equations analysis to compare across these time periods and demographic characteristics. RESULTS We found a proportional decrease in LtOT for chronic pain in the early months of the pandemic (OR = 0.94, P = .007) followed by an increase late pandemic (OR = 1.08, P = .002). Comparing late pandemic to prepandemic, identifying as Asian or Black, having fewer comorbidities, or living in an urban area were associated with higher likelihood of being prescribed LtOT. DISCUSSION The use of LtOT for chronic pain in primary care has increased from before to after the COVID-19 pandemic with racial/ethnic and geographic disparities. Future research is needed to understand these disparities in LtOT and their effect on patient outcomes.
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Affiliation(s)
- Sebastian T Tong
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Zihan Zheng
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Maria G Prado
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Imara I West
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Joseph W LeMaster
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Mary A Hatch
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Lili S Szabo
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Tracy M Anastas
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Kris Pui Kwan Ma
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
| | - Kari A Stephens
- From the University of Washington, Seattle, WA (STT, ZZ, MGP, IIW, MAH, LSS, TMA, KPKM, KAS); University of Kansas Medical Center , Kansas City, KS (JWL)
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Ma KPK, Mollis BL, West II, Rolfes J, Clifton J, Kessler R, Baldwin LM, Chakravarti P, Dewane S, Gerrish W, Holmes J, Karlson K, Roberts V, Stephens KA. Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices. Fam Med 2023; 55:530-538. [PMID: 37696022 PMCID: PMC10622053 DOI: 10.22454/fammed.2023.715036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Integrated behavioral health (BH) is becoming a preferred model of care for primary care because it improves patient outcomes and satisfaction. Little is known about whether residency practices are consistently modeling this preferred care model relative to real-world nonresidency practices. The study compared levels of BH integration, patient health outcomes, and satisfaction with care between residency practices and nonresidency practices with colocated BH providers. METHODS Baseline data were collected in 2018-2019 from 44 practices and their adult patients with chronic conditions participating in a cluster-randomized, pragmatic trial to improve BH integration. The sample included 18 (40.9%) residency and 26 (59.1%) nonresidency practices, with 1,817 (45.3%) patients from residency practices and 2,190 (54.7%) patients from nonresidency practices. Outcomes including BH integration levels (the Practice Integration Profile), patient health outcomes (the PROMIS-29), and patient satisfaction with care (the Consultation and Relational Empathy scale) were compared between residency and nonresidency practices using multivariate regression analyses. RESULTS No differences were found between BH integration levels, patient health outcomes, and patient satisfaction with care between residency and nonresidency practices. In a sample of primary care practices with colocated BH providers, residencies had BH integration and patient outcomes similar to real-world practices. CONCLUSIONS Primary care practices with residency programs reported comparable levels of BH integration, patient health outcomes, and patient satisfaction compared to practices without residency programs. Both types of practices require interventions and resources to help them overcome challenges associated with dissemination of high levels of BH integration.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Brenda L. Mollis
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Imara I. West
- Department of Psychiatry & Behavioral Sciences, University of Washington School of MedicineSeattle, WA
| | | | | | - Rodger Kessler
- Department of Family Medicine, University of Colorado Anschutz Medical CampusAurora, CO
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | | | | | - Winslow Gerrish
- Full Circle Health/Family Medicine Residency of IdahoBoise, ID
| | - John Holmes
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | | | - Verena Roberts
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Baldwin LM, Coronado GD, West II, Schwartz MR, Meenan RT, Vollmer WM, Petrik AF, Shapiro JA, Kulkarni-Sharma YR, Green BB. Health plan-based mailed fecal testing for colorectal cancer screening among dual-eligible Medicaid/Medicare enrollees: Outcomes of 2 program models. Cancer 2022; 128:410-418. [PMID: 34586630 PMCID: PMC9793727 DOI: 10.1002/cncr.33909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/17/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Health insurance plans are increasingly offering mailed fecal immunochemical test (FIT) programs for colorectal cancer (CRC) screening, but few studies have compared the outcomes of different program models (eg, invitation strategies). METHODS This study compares the outcomes of 2 health plan-based mailed FIT program models. In the first program (2016), FIT kits were mailed to all eligible enrollees; in the second program (2018), FIT kits were mailed only to enrollees who opted in after an outreach phone call. Participants in this observational study included dual-eligible Medicaid/Medicare enrollees who were aged 50 to 75 years and were due for CRC screening (1799 in 2016 and 1906 in 2018). Six-month FIT completion rates, implementation outcomes (eg, mailed FITs sent and reminders attempted), and program-related health plan costs for each program are described. RESULTS All 1799 individuals in 2016 were sent an introductory letter and a FIT kit. In 2018, all 1906 were sent an introductory letter, and 1905 received at least 1 opt-in call attempt, with 410 (21.5%) sent a FIT. The FIT completion rate was 16.2% (292 of 1799 [95% CI, 14.5%-17.9%]) in 2016 and 14.6% (278 of 1906 [95% CI, 13.0%-16.2%]) in 2018 (P = .36). The overall implementation costs were higher in 2016 ($40,156) than 2018 ($34,899), with the cost per completed FIT slightly higher in 2016 ($138) than 2018 ($126). CONCLUSIONS An opt-in mailed FIT program achieved FIT completion rates similar to those of a program mailing to all dual-eligible Medicaid/Medicare enrollees. LAY SUMMARY Health insurance plans can use different program models to successfully mail fecal test kits for colorectal cancer screening to dual-eligible Medicaid/Medicare enrollees, with nearly 1 in 6 enrollees completing fecal testing.
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Affiliation(s)
- Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Gloria D. Coronado
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Imara I. West
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Malaika R. Schwartz
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Richard T. Meenan
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - William M. Vollmer
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Amanda F. Petrik
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Jean A. Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Stephens KA, West II, Hallgren KA, Mollis B, Ma K, Donovan DM, Stuvek B, Baldwin LM. Service utilization and chronic condition outcomes among primary care patients with substance use disorders and co-occurring chronic conditions. J Subst Abuse Treat 2021; 112S:49-55. [PMID: 32220411 DOI: 10.1016/j.jsat.2020.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 10/31/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with a substance use disorder (SUD) often present with co-occurring chronic conditions in primary care. Despite the high co-occurrence of chronic medical conditions and SUD, little is known about whether chronic condition outcomes or related service utilization in primary care varies between patients with versus without documented SUDs. This study examined whether having a SUD influenced the use of primary care services and common chronic condition outcomes for patients with diabetes, hypertension, and obesity. METHODS A longitudinal cohort observational study examined electronic health record data from 21 primary care clinics in Washington and Idaho to examine differences in service utilization and clinical outcomes for diabetes, hypertension, and obesity in patients with and without a documented SUD diagnosis. Differences between patients with and without documented SUD diagnoses were compared over a three-year window for clinical outcome measures, including hemoglobin A1c, systolic and diastolic blood pressure, and body mass index, as well as service outcome measures, including number of encounters with primary care and co-located behavioral health providers, and orders for prescription opioids. Adult patients (N = 10,175) diagnosed with diabetes, hypertension, or obesity before the end of 2014, and who had ≥2 visits across a three-year window including at least one visit in 2014 (baseline) and at least one visit occurring 12 months or longer after the 2014 visit (follow-up) were examined. RESULTS Patients with SUD diagnoses and co-occurring chronic conditions were seen by providers more frequently than patients without SUD diagnoses (p's < 0.05), and patients with SUD diagnoses were more likely to be prescribed opioid medications. Chronic condition outcomes were no different for patients with versus without SUD diagnoses. DISCUSSION Despite the higher visit rates to providers in primary care, a majority of patients with SUD diagnoses and chronic medical conditions in primary care did not get seen by co-located behavioral health providers, who can potentially provide and support evidence informed care for both SUD and chronic conditions. Patients with chronic medical conditions also were more likely to get prescribed opioids if they had an SUD diagnosis. Care pathway innovations for SUDs that include greater utilization of evidence-informed co-treatment of SUDs and chronic conditions within primary care settings may be necessary for improving care overall for patients with comorbid SUDs and chronic conditions.
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Affiliation(s)
- Kari A Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America; Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America; Department of Biomedical Informatics & Medical Education, University of Washington, Seattle, WA, United States of America.
| | - Imara I West
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Brenda Mollis
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
| | - Kris Ma
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Dennis M Donovan
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA, United States of America
| | - Brenda Stuvek
- Alcohol & Drug Abuse Institute, University of Washington, Seattle, WA, United States of America
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
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Green BB, Baldwin LM, West II, Schwartz M, Coronado GD. Low Rates of Colonoscopy Follow-up After a Positive Fecal Immunochemical Test in a Medicaid Health Plan Delivered Mailed Colorectal Cancer Screening Program. J Prim Care Community Health 2021; 11:2150132720958525. [PMID: 32912056 PMCID: PMC7488888 DOI: 10.1177/2150132720958525] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Follow-up colonoscopy after a positive fecal immunochemical test (FIT) is necessary for colorectal cancer (CRC) screening to be effective. We report colonoscopy follow-up rates after a positive FIT overall and by population characteristics in the BeneFIT demonstration pilot, a Medicaid health insurance plan-delivered mailed FIT outreach program. METHODS In 2016, 2 health insurance plans in Oregon and in Washington state mailed FIT kits to Medicaid patients who, based on claims data, were overdue for CRC screening. We report follow-up colonoscopy completion rates after positive FIT, and differences in completion rates by age, sex, race, ethnicity, preferred language, and number of primary care visits in the prior year. This research was human subjects approved with a waiver of consent for data collection. RESULTS The FIT positivity rates in Health Plan Oregon and Health Plan Washington were 7.9% (39/488) and 14.6% (125/857), respectively. Colonoscopy completion rates within 12 months of the positive test were 35.9% (14/41) in Health Plan Oregon and 32.8% (41/125) in Health Plan Washington. Colonoscopy completion rates were higher among individuals who preferred a language other than English (Non-English speakers 70.0%, English speakers 31.3%, P = .04). CONCLUSION In a health plan-delivered mailed FIT outreach program, follow-up colonoscopy rates after a positive test were low. Additional interventions are needed to assure colonoscopy after a positive FIT test and to reap the benefits of screening.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | | | - Gloria D Coronado
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
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Meenan RT, Baldwin LM, Coronado GD, Schwartz M, Coury J, Petrik AF, West II, Green BB. Costs of Two Health Insurance Plan Programs to Mail Fecal Immunochemical Tests to Medicare and Medicaid Plan Members. Popul Health Manag 2020; 24:255-265. [PMID: 32609077 DOI: 10.1089/pop.2020.0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BeneFIT is a 4-year observational study of a mailed fecal immunochemical test (FIT) program in 2 Medicaid/Medicare health plans in Oregon and Washington. In Health Plan Oregon's (HPO) collaborative model, HPO mails FITs that enrollees return to their clinics for processing. In Health Plan Washington's (HPW) centralized model, FITs are mailed directly to enrollees who return them to a centralized laboratory. This paper examines model-specific Year 1 development and implementation costs and estimates costs per screened enrollee. Staff completed activity-based costing spreadsheets. Non-labor costs were from study and external data. Data matched each plan's 2016 development and implementation dates. HPO development costs were $23.0K, primarily administration (eg, clinic recruitment). HPW development costs were $37.3K, 38.8% for FIT selection and mailing/tracking protocols. Year 1 implementation costs were $51.6K for HPO and $139.7K for HPW, reflecting HPW's greater outreach. Labor was 50.4% ($26.0K) of HPO's implementation costs, primarily enrollee eligibility and processing returned FITs, and was shared by HPO ($17.0K) and 6 participating clinics ($9.0K). Labor was 10.5% of HPW's implementation costs, primarily administration and enrollee eligibility. HPO's implementation costs per enrollee were 12.3% higher ($18.36) than for HPW ($16.34). Similar proportions of completed FITs among screening-eligibles produced a 15% lower cost per completed FIT in HPW ($89.75) vs. HPO ($105.79). Implementation costs for HPO only (without clinic costs) were $15.16/mailed introductory letter, $16.09/mailed FIT, and $87.35/completed FIT, comparable to HPW. Results highlight cost implications of different approaches to implementing a mailed FIT program in 2 Medicaid/Medicare health plans.
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Affiliation(s)
- Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Malaika Schwartz
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer Coury
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Imara I West
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.,Family Medicine, Washington Permanente Medical Group, Seattle, Washington, USA
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Green BB, West II, Baldwin LM, Schwartz MR, Coury J, Coronado GD. Challenges in Reaching Medicaid and Medicare Enrollees in a Mailed Fecal Immunochemical Test Program. J Community Health 2020; 45:916-921. [PMID: 32219712 DOI: 10.1007/s10900-020-00809-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BeneFIT was a demonstration project that worked with a Medicaid/Medicare health plan to implement a mailed fecal immunochemical test (FIT) program. The goal was to reach age-eligible enrollees who were due for colorectal cancer (CRC) screening and prompt them to complete a FIT. One health insurance plan collaborated with six federally qualified health centers (FQHCs) in Oregon. Reach was defined as the percent of eligible individuals overdue for CRC screening who were mailed a FIT in 2016. We examined patient-level factors associated with reach, using multivariable log binomial regression and FIT completion rates at 6 months. The health plan identified 3386 age-eligible members overdue for CRC screening. Of these, 2615 (77.2%) were reached (mailed FIT kits) and 771 (22.8%) were not; 478 (14.1%) because they were not considered to be clinic patients and 290 (8.6%) because of mailing issues. Patient-level factors associated with not being reached were: being male, being Medicaid-insured (vs. Medicare), and having no primary care visits (vs. 4+ visits) in the last year. Among all enrollees identified as overdue for CRC screening, FIT completion rates at 6 months were 14.8% overall and 18.5% in the subgroup reached. In a mailed FIT program, a health insurance plan attempted to reach as many enrollees overdue for CRC screening as possible, however 22.8% were not mailed a FIT. Additional efforts are needed to ensure that the hardest to reach enrollees can participate in CRC screening.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Av. Suite 1600, Seattle, WA, 98101, USA.
| | - Imara I West
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Laura Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Malaika R Schwartz
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | | | - Gloria D Coronado
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
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Coronado GD, Green BB, West II, Schwartz MR, Coury JK, Vollmer WM, Shapiro JA, Petrik AF, Baldwin LM. Direct-to-member mailed colorectal cancer screening outreach for Medicaid and Medicare enrollees: Implementation and effectiveness outcomes from the BeneFIT study. Cancer 2019; 126:540-548. [PMID: 31658375 PMCID: PMC7004121 DOI: 10.1002/cncr.32567] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/12/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022]
Abstract
Background Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. To the authors' knowledge, little is known regarding the effectiveness of direct‐to‐member outreach by Medicaid health insurance plans to raise colorectal cancer screening use, nor how best to deliver such outreach. Methods BeneFIT is a hybrid implementation‐effectiveness study of 2 program models that health plans developed for a mailed fecal immunochemical test (FIT) intervention. The programs differed with regard to whether they used a centralized approach (Health Plan Washington) or collaborated with health centers (Health Plan Oregon). The primary implementation outcome of the current study was the percentage of eligible enrollees to whom the plans delivered each intervention component. The primary effectiveness outcome was the rate of FIT completion within 6 months of mailing of the introductory letter. Results The health plans identified 12,000 eligible enrollees (8551 in Health Plan Washington and 3449 in Health Plan Oregon). Health Plan Washington mailed an introductory letter and FIT kit to 8551 enrollees (100%) and delivered a reminder call to 839 (10.3% of the 8132 attempted). Health Plan Oregon mailed an introductory letter, and a letter and FIT kit plus a reminder postcard to 2812 enrollees (81.5%) and 2650 enrollees (76.8%), respectively. FIT completion rates were 18.2% (1557 of 8551 enrollees) in Health Plan Washington. In Health Plan Oregon, completion rates were 17.4% (488 of 2812 enrollees) among enrollees who were mailed an introductory letter and 18.3% (484 of 2650 enrollees) among enrollees who also were mailed a FIT kit plus reminder postcard. Conclusions The implementation of mailed FIT outreach by health plans may be effective and could reach many individuals at risk of developing colorectal cancer. Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. The implementation of mailed fecal immunochemical test outreach among health plans may be effective and could reach many individuals at risk of developing colorectal cancer.
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Affiliation(s)
- Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Beverly B Green
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Imara I West
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Malaika R Schwartz
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | - William M Vollmer
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jean A Shapiro
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda F Petrik
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington
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Godfrey EM, West II, Holmes J, Keppel GA, Baldwin LM. Use of an electronic health record data sharing system for identifying current contraceptive use within the WWAMI region Practice and Research Network. Contraception 2018; 98:476-481. [PMID: 29936151 DOI: 10.1016/j.contraception.2018.06.005] [Citation(s) in RCA: 5] [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: 02/14/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the ability of electronic health record (EHR) data extracted into a data-sharing system to accurately identify contraceptive use. STUDY DESIGN We compared rates of contraceptive use from electronic extraction of EHR data via a data-sharing system and manual abstraction of the EHR among 142 female patients ages 15-49 years from a family medicine clinic within a primary care practice-based research network (PBRN). Cohen's kappa coefficient measured agreement between electronic extraction and manual abstraction. RESULTS Manual abstraction identified 62% of women as contraceptive users, whereas electronic extraction identified only 27%. Long acting reversible (LARC) methods had 96% agreement (Cohen's kappa 0.78; confidence interval, 0.57-0.99) between electronic extraction and manual abstraction. EHR data extracted via a data-sharing system was unable to identify barrier or over-the-counter contraceptives. CONCLUSIONS Electronic extraction found substantially lower overall rates of contraceptive method use, but produced more comparable LARC method use rates when compared to manual abstraction among women in this study's primary care clinic. IMPLICATIONS Quality metrics related to contraceptive use that rely on EHR data in this study's data-sharing system likely under-estimated true contraceptive use.
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Affiliation(s)
- Emily M Godfrey
- Department of Family Medicine, University of Washington, Box 354982, Seattle, WA 98105, USA; Department of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA.
| | - Imara I West
- Department of Family Medicine, University of Washington, Box 354982, Seattle, WA 98105, USA
| | - John Holmes
- Departments of Pharmacy Practice and Family Medicine, Idaho State University, 465 Memorial Drive, Pocatello, ID 83201, USA
| | - Gina A Keppel
- Department of Family Medicine, University of Washington, Box 354982, Seattle, WA 98105, USA; Institute of Translational Health Sciences, Box 357184, Seattle, WA 98195, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Box 354982, Seattle, WA 98105, USA; Institute of Translational Health Sciences, Box 357184, Seattle, WA 98195, USA
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Krupski A, West II, Scharf DM, Hopfenbeck J, Andrus G, Joesch JM, Snowden M. Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care. Psychiatr Serv 2016; 67:1233-1239. [PMID: 27364815 DOI: 10.1176/appi.ps.201500424] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This evaluation was designed to assess the impact of providing integrated primary and mental health care on utilization and costs for outpatient medical, inpatient hospital, and emergency department treatment among persons with serious mental illness. METHODS Two safety-net, community mental health centers that received a Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration (PBHCI) grant were the focus of this study. Clinic 1 had a ten-year history of providing integrated services whereas clinic 2 began integrated services with the PBHCI grant. Difference-in-differences (DID) analyses were used to compare individuals enrolled in the PBHCI programs (N=373, clinic 1; N=389, clinic 2) with propensity score-matched comparison groups of equal size at each site by using data obtained from medical records. RESULTS Relative to the comparison groups, a higher proportion of PBHCI clients used outpatient medical services at both sites following program enrollment (p<.003, clinic 1; p<.001, clinic 2). At clinic 1, PBHCI was also associated with a reduction in the proportion of clients with an inpatient hospital admission (p=.04) and a trend for a reduction in inpatient hospital costs per member per month of $217.68 (p=.06). Hospital-related cost savings were not observed for PBHCI clients at clinic 2 nor were there significant differences between emergency department use or costs for PBHCI and comparison groups at either clinic. CONCLUSIONS Investments in PBHCI can improve access to outpatient medical care for persons with severe mental illness and may also curb hospitalizations and associated costs in more established programs.
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Affiliation(s)
- Antoinette Krupski
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - Imara I West
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - Deborah M Scharf
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - James Hopfenbeck
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - Graydon Andrus
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - Jutta M Joesch
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
| | - Mark Snowden
- Dr. Krupski, Ms. West, and Dr. Snowden are with the Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle (e-mail: ). Dr. Scharf is with the RAND Corporation, Pittsburgh. Dr. Hopfenbeck and Mr. Andrus are with the Downtown Emergency Service Center, Seattle. Dr. Joesch is with the King County Office of Performance, Strategy, and Budget, Seattle
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11
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Maynard C, Graves M, West II, Bumgardner K, Krupski A, Roy-Byrne P. Chronic Disease and Chemical Dependency Treatment in Primary Care Patients With Problem Drug Use. J Addict Dis 2016; 34:323-9. [PMID: 26280390 DOI: 10.1080/10550887.2015.1078133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article examines whether chronic disease is associated with chemical dependency treatment in primary care patients with problem drug use. Chronic disease was common in 781 disadvantaged individuals who had problem drug use and were seen in primary care clinics affiliated with a public safety-net hospital. Individuals had, on average, 5.4 chronic medical conditions, and overall 57% had low severity chronic disease. In the year following enrollment, 14% had chemical dependency treatment. Severity of chronic disease was not associated with chemical dependency treatment (p = .26). In summary, chronic disease neither hindered chemical dependency treatment, nor did it facilitate such treatment.
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Affiliation(s)
- Charles Maynard
- a Department of Health Services , University of Washington , Seattle , Washington , USA
| | - Meredith Graves
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
| | - Imara I West
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
| | - Kristin Bumgardner
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
| | - Antoinette Krupski
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
| | - Peter Roy-Byrne
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA
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12
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Carmel A, Ries R, West II, Bumgardner K, Roy-Byrne P. Suicide risk and associated demographic and clinical correlates among primary care patients with recent drug use. Am J Drug Alcohol Abuse 2016; 42:351-7. [PMID: 26910262 DOI: 10.3109/00952990.2015.1133634] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is an increased need to prepare primary care clinicians to effectively gauge the risk of suicidal behavior occurring within primary care patients who may abuse drugs, especially those served in safety-net settings. OBJECTIVES The objectives of this paper were to explore suicide risk in a population of individuals endorsing recent drug use, and to describe patient demographic, medical, psychiatric, social, and substance use characteristics across different levels of suicide risk. METHODS A total of 867 primary care patients with reported drug use in the previous 90 days were studied. Based upon their responses to two Addiction Severity Index questions, four suicide risk categories were constructed: (1) low risk; (2) moderate-low (suicidal ideation in the past 30 days); (3) moderate-high (history of a lifetime suicide attempt); and (4) high risk (history of a lifetime suicide attempt and suicidal ideation in the past 30 days). The association between suicide risk groups and demographic and clinical variables were assessed. RESULTS A total of 40% of primary care patients endorsing recent drug use reported a lifetime suicide attempt. Compared to individuals in other suicide risk groups, individuals at high suicide risk had higher rates of substance use severity, recently used two or more substances, and were more likely to have a comorbid psychiatric condition. CONCLUSION These findings indicate that the percentage of patients with suicide risk may be higher among patients with recent drug use. Primary care clinicians should be aware that they may be encountering patients with suicide risk among those with recent drug use.
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Affiliation(s)
- Adam Carmel
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA.,b Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | - Richard Ries
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Imara I West
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Kristin Bumgardner
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Peter Roy-Byrne
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
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13
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Simpson SA, Joesch JM, West II, Pasic J. Who's boarding in the psychiatric emergency service? West J Emerg Med 2015; 15:669-74. [PMID: 25247041 PMCID: PMC4162727 DOI: 10.5811/westjem.2014.5.20894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/27/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. Methods We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression. Results 521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Conclusion Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients.
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Affiliation(s)
- Scott A Simpson
- University of Colorado School of Medicine, Department of Psychiatry, Denver, Colorado
| | - Jutta M Joesch
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Imara I West
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Jagoda Pasic
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
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14
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Roy-Byrne P, Maynard C, Bumgardner K, Krupski A, Dunn C, West II, Donovan D, Atkins DC, Ries R. Are medical marijuana users different from recreational users? The view from primary care. Am J Addict 2015; 24:599-606. [DOI: 10.1111/ajad.12270] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 05/08/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Charles Maynard
- Department of Health Services, School of Public Health; University of Washington; Seattle Washington
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Chris Dunn
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Imara I. West
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Dennis Donovan
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, School of Medicine; University of Washington; Seattle Washington
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15
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Bell JF, Krupski A, Joesch JM, West II, Atkins DC, Court B, Mancuso D, Roy-Byrne P. A randomized controlled trial of intensive care management for disabled Medicaid beneficiaries with high health care costs. Health Serv Res 2014; 50:663-89. [PMID: 25427656 DOI: 10.1111/1475-6773.12258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate outcomes of a registered nurse-led care management intervention for disabled Medicaid beneficiaries with high health care costs. DATA SOURCES/STUDY SETTING Washington State Department of Social and Health Services Client Outcomes Database, 2008-2011. STUDY DESIGN In a randomized controlled trial with intent-to-treat analysis, outcomes were compared for the intervention (n = 557) and control groups (n = 563). A quasi-experimental subanalysis compared outcomes for program participants (n = 251) and propensity score-matched controls (n = 251). DATA COLLECTION/EXTRACTION METHODS Administrative data were linked to describe costs and use of health services, criminal activity, homelessness, and death. PRINCIPAL FINDINGS In the intent-to-treat analysis, the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod. In the subanalysis, participants had fewer unplanned hospital admissions and lower associated costs; higher prescription drug costs; higher odds of long-term care service use; higher drug/alcohol treatment costs; and lower odds of homelessness. CONCLUSIONS We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management. Among participants, care management may have the potential to increase access to needed care, slow growth in the number and therefore cost of unplanned hospitalizations, and prevent homelessness. These findings apply to start-up care management programs targeted at high-cost, high-risk Medicaid populations.
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Affiliation(s)
- Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817
| | - Antoinette Krupski
- Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.,Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD
| | - Jutta M Joesch
- Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.,Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD
| | - Imara I West
- Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.,Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD
| | - David C Atkins
- Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.,Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD
| | - Beverly Court
- Washington State Department of Social and Health Services, Research and Data Analysis Division, Olympia, WA
| | - David Mancuso
- Washington State Department of Social and Health Services, Research and Data Analysis Division, Olympia, WA
| | - Peter Roy-Byrne
- Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), University of Washington at Harborview Medical Center, Seattle, WD.,Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WD
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16
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Roy-Byrne P, Bumgardner K, Krupski A, Dunn C, Ries R, Donovan D, West II, Maynard C, Atkins DC, Graves MC, Joesch JM, Zarkin GA. Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial. JAMA 2014; 312:492-501. [PMID: 25096689 PMCID: PMC4599980 DOI: 10.1001/jama.2014.7860] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although brief intervention is effective for reducing problem alcohol use, few data exist on its effectiveness for reducing problem drug use, a common issue in disadvantaged populations seeking care in safety-net medical settings (hospitals and community health clinics serving low-income patients with limited or no insurance). OBJECTIVE To determine whether brief intervention improves drug use outcomes compared with enhanced care as usual. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial with blinded assessments at baseline and at 3, 6, 9, and 12 months conducted in 7 safety-net primary care clinics in Washington State. Of 1621 eligible patients reporting any problem drug use in the past 90 days, 868 consented and were randomized between April 2009 and September 2012. Follow-up participation was more than 87% at all points. INTERVENTIONS Participants received a single brief intervention using motivational interviewing, a handout and list of substance abuse resources, and an attempted 10-minute telephone booster within 2 weeks (n = 435) or enhanced care as usual, which included a handout and list of substance abuse resources (n = 433). MAIN OUTCOMES AND MEASURES The primary outcomes were self-reported days of problem drug use in the past 30 days and Addiction Severity Index-Lite (ASI) Drug Use composite score. Secondary outcomes were admission to substance abuse treatment; ASI composite scores for medical, psychiatric, social, and legal domains; emergency department and inpatient hospital admissions, arrests, mortality, and human immunodeficiency virus risk behavior. RESULTS Mean days used of the most common problem drug at baseline were 14.40 (SD, 11.29) (brief intervention) and 13.25 (SD, 10.69) (enhanced care as usual); at 3 months postintervention, means were 11.87 (SD, 12.13) (brief intervention) and 9.84 (SD, 10.64) (enhanced care as usual) and not significantly different (difference in differences, β = 0.89 [95% CI, -0.49 to 2.26]). Mean ASI Drug Use composite score at baseline was 0.11 (SD, 0.10) (brief intervention) and 0.11 (SD, 0.10) (enhanced care as usual) and at 3 months was 0.10 (SD, 0.09) (brief intervention) and 0.09 (SD, 0.09) (enhanced care as usual) and not significantly different (difference in differences, β = 0.008 [95% CI, -0.006 to 0.021]). During the 12 months following intervention, no significant treatment differences were found for either variable. No significant differences were found for secondary outcomes. CONCLUSIONS AND RELEVANCE A one-time brief intervention with attempted telephone booster had no effect on drug use in patients seen in safety-net primary care settings. This finding suggests a need for caution in promoting widespread adoption of this intervention for drug use in primary care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00877331.
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Affiliation(s)
- Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Chris Dunn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Dennis Donovan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Imara I West
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Charles Maynard
- Department of Health Services, School of Public Health, University of Washington, Seattle
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Meredith C Graves
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle
| | - Jutta M Joesch
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle3King County Office of Performance, Strategy and Budget, Seattle, Washington
| | - Gary A Zarkin
- RTI International, Research Triangle Park, North Carolina
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17
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Simpson SA, Joesch JM, West II, Pasic J. Risk for physical restraint or seclusion in the psychiatric emergency service (PES). Gen Hosp Psychiatry 2014; 36:113-8. [PMID: 24268565 DOI: 10.1016/j.genhosppsych.2013.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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] [Received: 06/15/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We describe risk factors associated with patients experiencing physical restraint or seclusion in the psychiatric emergency service (PES). METHODS We retrospectively reviewed medical records, nursing logs and quality assurance data for all adult patient encounters in a PES over a 12-month period (June 1, 2011-May 31, 2012). Descriptors included demographic characteristics, diagnoses, laboratory values, and clinician ratings of symptom severity. χ(2) and multivariate logistic regression analyses were performed. RESULTS Restraint/seclusion occurred in 14% of 5335 patient encounters. The following characteristics were associated with restraint/seclusion: arrival to the PES in restraints; referral not initiated by the patient; arrival between 1900 and 0059 hours; bipolar mania or mixed episode; and clinician rating of severe disruptiveness, psychosis or insight impairment. Severe suicidality and a depression diagnosis were associated with less risk of restraint or seclusion. CONCLUSION Acute symptomatology and characteristics of the encounter were more likely to be associated with restraint/seclusion than patient demographics or diagnoses. These findings support recent guidelines for the treatment of agitation and can help clinicians identify patients at risk of behavioral decompensation.
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Affiliation(s)
- Scott A Simpson
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA.
| | - Jutta M Joesch
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Imara I West
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jagoda Pasic
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98195, USA
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Austin AA, Druschel CM, Tyler MC, Romitti PA, West II, Damiano PC, Robbins JM, Burnett W. Interdisciplinary craniofacial teams compared with individual providers: is orofacial cleft care more comprehensive and do parents perceive better outcomes? Cleft Palate Craniofac J 2010; 47:1-8. [PMID: 20078199 DOI: 10.1597/08-250.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The primary objective was to examine whether children with orofacial clefts received more comprehensive care and whether their parents perceived better outcomes if the care was delivered by interdisciplinary teams compared with individual providers. DESIGN Data about services received and outcomes were collected from mothers of children with orofacial clefts. PARTICIPANTS Mothers of children born between 1998 and 2003 with orofacial clefts from Arkansas, Iowa, and New York who participated in the National Birth Defects Prevention Study were eligible. MAIN OUTCOME MEASURE(S) Services and treatments received and maternal perception of cleft care, health status, aesthetics, and speech were evaluated by team care status. RESULTS Of 253 children, 24% were not receiving team care. Of those with cleft lip and palate, 86% were enrolled in team care. Compared with children with team care, those without had fewer surgeries and were less likely to have seen a dentist, received a hearing test, or had a genetic consultation. Mothers of children lacking team care were twice as likely to give lower ratings for overall cleft care; maternal perceptions of global health, facial appearance, and speech did not differ by team care status. CONCLUSIONS Recommended care tended to be received more often among those with team care. A larger, longitudinal study might answer questions about whether team care provides the best care and the role that type and severity of the condition and racial/ethnic differences play in the services received and outcomes experienced.
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Affiliation(s)
- April A Austin
- Congenital Malformations Registry, New York State Department of Health, 547 River Street, Room 200, Troy, NY 12180, USA
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