Mental Health Service Use by Medicaid-Enrolled Children and Adolescents in Primary Care Safety-Net Clinics.
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ABSTRACT: Objective
Little is known about the role of primary care safety-net clinics, including federally qualified health centers and rural health clinics, in providing mental health services to youths. This study examined correlates and quality of mental health care for youths treated in these settings.Methods
Medicaid claims data (2008-2010) from nine states were used to identify youths initiating medication for attention-deficit hyperactivity disorder (ADHD) (N=6,433) and youths with an incident depression diagnosis (N=13,209). The authors identified youths who received no ADHD or depression-related visits in a primary care safety-net clinic, some (but less than most) visits in these clinics, and most visits in these clinics. Using bivariate and regression analyses, they examined correlates of mental health treatment in these settings and whether mental health visits in these settings were associated with quality measures.Results
Only 13.5% of the ADHD cohort and 7.2% of the depression cohort sought any ADHD- or depression-related visits in primary care safety-net clinics. Residence in a county with a higher (versus lower) percentage of residents living in an urban area was negatively associated with receiving the majority of mental health visits in these settings (p<0.05). Compared with youths with no visits in these settings, youths who received most of their mental health treatment in these settings received lower-quality care on five of six measures (p<0.01).Conclusions
As investment in the expansion of mental health services in primary care safety-net clinics grows, future research should assess whether these resources translate into improved mental health care access and quality for Medicaid-enrolled youths.
SUBMITTER: Cummings JR
PROVIDER: S-EPMC8052634 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThere is a need for new strategies to improve the success of obesity treatment within the primary care setting.ObjectiveTo determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care.DesignTwelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital.ParticipantsFrom a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention.InterventionsMedical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months.Main measuresThe primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss.Key resultsOverall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes.ConclusionsAccess to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT01922934.
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Project description:ObjectivesTo understand mandated behavioral health (BH) screening in Massachusetts Medicaid including characteristics of screened children, predictors of positive screens, and whether screening identifies children without a previous BH history.MethodsMassachusetts mandated BH screening in particularly among underidentified groups. 2008. Providers used a billing code and modifier to indicate a completed screen and whether a BH need was identified. Using MassHealth claims data, children with ? 300 days of eligibility in fiscal year (FY) 2009 were identified and categorized into groups based on first use of the modifier, screening code, or claim. Bivariate analyses were conducted to determine differences among groups. BH history was examined by limiting the sample to those continuously enrolled in FY 2008 and 2009. Multivariate logistic regression was used to determine predictors of positive screens.ResultsOf 355,490 eligible children, 46% had evidence of screening. Of those with modifiers, 12% were positive. Among continuously enrolled children (FY 2008 and FY 2009) with evidence of screening, 43% with positive modifiers had no BH history. This "newly identified" group were more likely to be female, younger, minority, and from rural residences (P < .0001). Among children with modifiers; gender (male), age (5-7), being in foster care, recent BH history, and Hispanic ethnicity predicted having a positive modifier.ConclusionsThe high rate of newly identified Medicaid children with a BH need suggests that screening is performing well, particularly among underidentified groups. To better assess screening value, future work on cost-effectiveness and the impact on subsequent mental health treatment is needed.
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Project description:To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid-enrolled children over time.Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007.Repeated cross-sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time.Center for Medicaid Services data extracted by means of age, ICD-9 codes, service use intensity, and National Drug Classification codes.Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis.In the context of safety concerns, disproportionate antipsychotic use among youth with nonapproved indications illustrates the need for more generalized efficacy data in pediatric populations.
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