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Treatment utilization and unmet treatment need among Hispanics following brief intervention.

ABSTRACT: In a large randomized trial examining ethnic differences in response to a brief alcohol intervention following an alcohol-related injury, we showed that Hispanics, but not non-Hispanics, were more likely to reduce alcohol intake in comparison with treatment as usual (Addiction 105:62, 2010). The current study evaluates whether the observed improvements in drinking outcomes previously reported among Hispanics following brief intervention might be related to prior or subsequent treatment utilization.This study is a secondary analysis of data collected in a randomized clinical trial that evaluated ethnic differences in the effect of a brief motivational intervention (BMI) on alcohol use among medical inpatients admitted for alcohol-related injury. For this study, statistical analyses were carried out to compare alcohol use, alcohol problems, treatment utilization, and unmet treatment need between Hispanic (n = 537) and non-Hispanic White (n = 668) inpatients. In addition, we examined the relationship between prior treatment utilization and unmet treatment need and alcohol use outcomes following brief intervention and the impact of brief intervention on subsequent treatment utilization and unmet treatment need.In comparison with non-Hispanic Whites, Hispanics at baseline reported heavier drinking, more alcohol problems, greater unmet treatment need, and lower rates of treatment utilization. Among Hispanics, multilevel analyses showed that prior treatment utilization or unmet treatment need did not moderate the effect of BMI on alcohol outcomes. Furthermore, BMI did not significantly impact subsequent treatment utilization or unmet treatment need among Hispanics. Finally, treatment utilization and unmet treatment need at 6 months were not significant mediators between BMI and alcohol use outcomes at follow-up.The benefits of brief intervention among Hispanics do not appear to be better explained by subsequent engagement in mutual help groups or formal substance abuse treatment. Prior history of treatment, regardless of the severity of alcohol problems, does not appear to influence the impact of brief intervention on alcohol use among Hispanics. These findings support prior results reporting the benefits of brief intervention among Hispanics and demonstrate that these improvements are not related to prior or subsequent treatment utilization.

SUBMITTER: Field CA

PROVIDER: S-EPMC3484238 | biostudies-literature | 2013 Feb

REPOSITORIES: biostudies-literature

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Treatment utilization and unmet treatment need among Hispanics following brief intervention.

Field Craig A CA Cochran Gerald G Caetano Raul R

Alcoholism, clinical and experimental research 20120723 2

<h4>Background</h4>In a large randomized trial examining ethnic differences in response to a brief alcohol intervention following an alcohol-related injury, we showed that Hispanics, but not non-Hispanics, were more likely to reduce alcohol intake in comparison with treatment as usual (Addiction 105:62, 2010). The current study evaluates whether the observed improvements in drinking outcomes previously reported among Hispanics following brief intervention might be related to prior or subsequent ...[more]

PMID: 22823528

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Project description:BackgroundMore than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi. Previous studies in Malawi on childhood disability and the impact of musculoskeletal impairment (MSI) on the lives of children have been done but on a small scale and have not used disability measurement tools designed for children. Therefore in this study, we aimed to estimate the MSI prevalence, causes, and the treatment need among children aged 16 years or less in Malawi.MethodsThis study was carried out as a national cross sectional survey. Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation.ResultsOf 3792 children aged 16 or less who were enumerated, 3648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7-7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6000-33,000) children in need of orthopaedic surgery. Low parents' educational level was one factor associated with an increased risk of MSI.ConclusionThis survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country.

Project description:IMPORTANCE:Medicare beneficiaries with high medical needs can benefit from Advance Care Planning (ACP). Medicare reimburses clinical providers for ACP discussions, but it is unknown whether high-need beneficiaries are receiving this service. OBJECTIVE:To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries with the non-high-needs Medicare population. DESIGN:Retrospective analysis of Medicare Fee-for-Service (FFS) claims in 2017 comparing high-need beneficiaries (seriously ill, frail, ESRD, and disabled) with non-high need beneficiaries. SETTING:Nationally representative FFS Medicare 20% sample. PARTICIPANTS:Medicare beneficiaries were assigned to one of the following classifications: seriously ill (65+), frail (65+), seriously ill & frail (65+); non-high need (65+); end stage renal disease (ESRD) or disabled (<65). All participants had data available for years 2016-2017. EXPOSURE:Receipt of a billed ACP discussion, CPT codes 99497 or 99498. MAIN OUTCOME AND MEASURE:Rates of billed ACP visits were compared between high-need patients and non-high-need patients. Rates were adjusted for the 65+ population for sex, age, race/ethnicity, Charlson comorbidity index, Medicare/Medicaid dual eligibility status, and Hospital Referral Region. RESULTS:Among the 65+ groups, those most likely to have a billed ACP discussion included seriously ill & frail (5.2%), seriously ill (4.2%), and frail (3.3%). Rates remained consistent after adjusting (4.5%, 4.0%, 3.1%, respectively). Each subgroup differed significantly (p < .05) from non-high need beneficiaries (2.3%) in both unadjusted and adjusted analyses. Among the <65 high need groups, the rates were 2.7% for ESRD and 1.3% for the disabled (the latter p < .05 compared with non-high needs). CONCLUSIONS AND RELEVANCE:While rates of billed ACP discussions varied among patient groups with high medical needs, overall they were relatively low, even among a cohort of patients for whom ACP may be especially relevant.

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Treatment utilization and unmet treatment need among Hispanics following brief intervention.

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Treatment utilization and unmet treatment need among Hispanics following brief intervention.

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