Dataset Information

Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort.

ABSTRACT: Importance:The increased use of psychiatric services in the US pediatric population raises concerns about the appropriate use of psychotropic medications for very young children. Objective:To assess the longitudinal patterns of psychotropic medication use in association with diagnosis and duration of use in a Medicaid-insured birth cohort. Design, Setting, and Participants:A cohort design was applied to computerized Medicaid administrative claims data for 35?244 children born in a mid-Atlantic state in 2007 and followed up for up to 96 months through December 31, 2014. Children were included in the birth cohort if they had an enrollment record at birth or within 3 months of birth and at least 6 months of continuous enrollment from birth. The cohort represents 92.2% of 38?225 Medicaid-insured newborns in 2007. Exposures:Mental health treatments from birth through age 7 years. Main Outcomes and Measures:Cumulative incidence of first psychiatric diagnosis and psychotropic medication use (monotherapy or concomitant use of psychotropic medications) from birth through age 7 years, total and by sex, and the cumulative incidence of the use of psychosocial services (age, 0-7 years) as well as the annual duration of medication use (ie, number of days of psychotropic medication use among children 3-7 years of age). Results:Of the 35?244 children in the cohort, 17?267 were girls and 17?977 were boys. By age 8 years, 4550 children in the birth cohort (19.7% [percentage adjusted for right censoring]) had received a psychiatric diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290-319); 2624 of these diagnoses (57.7%) were behavioral (codes 312, 313, or 314). Girls were more likely than boys to receive an incident psychiatric diagnosis of adjustment disorder (355 of 1598 [22.2%] vs 427 of 2952 [14.5%]; P?

SUBMITTER: Pennap D

PROVIDER: S-EPMC6137539 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort.

Pennap Dinci D Zito Julie M JM Santosh Paramala J PJ Tom Sarah E SE Onukwugha Eberechukwu E Magder Laurence S LS

JAMA pediatrics 20180601 6

<h4>Importance</h4>The increased use of psychiatric services in the US pediatric population raises concerns about the appropriate use of psychotropic medications for very young children.<h4>Objective</h4>To assess the longitudinal patterns of psychotropic medication use in association with diagnosis and duration of use in a Medicaid-insured birth cohort.<h4>Design, setting, and participants</h4>A cohort design was applied to computerized Medicaid administrative claims data for 35 244 children bo ...[more]

PMID: 29710205

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Project description:ObjectiveTo describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon.DesignCross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology).Participants420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015.OutcomePresence of any visit with each provider type, risk-adjusted for sex, age, and health conditions.ResultsRelative to commercially insured individuals, Medicaid enrollees had lower rates of access to primary care physicians (- 11.82%; CI - 12.01 to - 11.63%) and to some specialists (e.g., obstetrics and gynecology, dermatology), but had equivalent or higher rates of access to NPs and PAs providing primary care (4.33%; CI 4.15 to 4.52%) and a variety of mental health providers (including psychiatrists, NPs and PAs, and other behavioral specialists). Across all providers, the largest gaps in Medicaid-commercial access rates were observed in rural counties. The Medicaid-commercial patient mix was evenly distributed across primary care physicians, suggesting that access for Medicaid patients was not limited to a small subset of primary care providers.ConclusionsThis cross-sectional study found lower rates of access to primary care physicians for Medicaid enrollees, but Medicaid-commercial differences in access rates were not present across all provider types and displayed substantial variability across counties. Policies that address rural-urban differences as well as Medicaid-commercial differences-such as expansions of telemedicine or changes in the workforce mix-may have the largest impact on improving access to care across a wide range of populations.

Project description:ImportanceAn intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care.ObjectiveTo examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age.Design, setting, and participantsA cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled.InterventionFive clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care.Main outcomes and measuresThere were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care.ResultsOf the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income <$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, -5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care).Conclusions and relevanceThe intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care.Trial registrationClinicalTrials.gov Identifier: NCT03797898.

Dataset Information

Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort.

Publications

Patterns of Early Mental Health Diagnosis and Medication Treatment in a Medicaid-Insured Birth Cohort.

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