Literature Collection

BACKGROUND: The Patient Protection and Affordable Care Act increased funding for integrated care to improve access to quality health care among underserved populations. There is evidence that integrated care decreases inequities in access and quality of mental health care among Hispanic clients. Increasing integrated care at Hispanic-Serving Organizations may help to eliminate mental health service disparities among Hispanic clients. METHOD: Using organizational responses from the 2014 and 2016 waves of the National Mental Health Service survey, this study conducted multivariate logistic analyses to assess whether the ACA policies related to integrated care increased the provision of integrated addictions treatment and primary care at mental health Hispanic-Serving Organizations, relative to Mainstream Organizations. RESULTS: Findings showed that Hispanic-Serving Organizations (54.4%) were less likely to provide integrated health services than Mainstream Organizations (59.1%) after the ACA. However, federal funding to help organizations transition into integrated care services (AOR = 1.74, p = 0.01) and accepting Medicaid payments (AOR = 1.59, p = 0.01) increased the provision of integrated care services at Hispanic-Serving Organizations over time. CONCLUSIONS: Health care policies that increase funding to adopt integrated health services at community Hispanic-Serving Organizations may help decrease inequities in mental health access for Hispanics in the United States.

BACKGROUND: Opioid use disorder (OUD) affects approximately 21.9 million people worldwide. This study aims to determine the association between age of onset of opioid use and comorbid disorders, both physical and psychiatric, in patients receiving methadone maintenance treatment (MMT) for OUD. Understanding this association may inform clinical practice about important prognostic factors of patients on MMT, enabling clinicians to identify high-risk patients. METHODS: This study includes data collected between June 2011 and August 2016 for the Genetics of Opioid Addiction research collaborative between McMaster University and the Canadian Addiction Treatment Centers. All patients were interviewed by trained health professionals using the Mini-International Neuropsychiatric Interview and case report forms. Physical comorbidities were verified using patients' electronic medical records. A multi-variable logistic regression model was constructed to determine the strength of the association between age of onset of opioid use and the presence of physical or psychiatric comorbidity while adjusting for current age, sex, body mass index, methadone dose and smoking status. RESULTS: Data from 627 MMT patients with a mean age of 38.8 years (SD = 11.07) were analyzed. Individuals with an age of onset of opioid use younger than 18 years were found to be at higher odds for having a physical or psychiatric comorbid disorder compared to individuals with an age of onset of opioid use of 31 years or older (odds ratio 2.94, 95% confidence interval 1.20, 7.19, p = 0.02). A significant association was not found between the risk of having a comorbidity and an age of onset of opioid use between 18 and 25 years or 26 and 30 years, compared to an age of onset of opioid use of 31 years or older. CONCLUSION: Our study demonstrates that the younger one begins to use opioids, the greater their chance of having a physical or psychiatric co-morbidity. Understanding the risk posed by an earlier onset of opioid use for the later development of comorbid disorders informs clinical practice about important prognostic predictors and aids in the identification of high-risk patients.

BACKGROUND: Unhealthy alcohol use (UAU) is common in primary care populations and can significantly impact mental health. Screening for UAU within primary care is increasingly used for point-in-time identification of UAU, but it is less clear whether changes in alcohol screening scores effectively capture changes in alcohol-related risk. METHODS: This retrospective cohort study used data from adult primary care patients in a Northwest US health system who had completed two AUDIT-C screens 11-24 months apart (T1, T2). Scores were grouped into five categories from no use to very high-risk UAU. Generalized estimating equation models tested whether changes in AUDIT-C categories from T1 to T2 were associated with changes in risk for nonaddiction mental health acute care utilization (emergency department or hospital admission) over 1 year after T1 and T2. RESULTS: Of 165,101 patients (61% female; mean age 55), mental health acute care utilization risks were 0.9% after T1 and 0.8% after T2. Compared to those with stable drinking (T1 utilization 0.8%, T2 0.8%), mental health acute care utilization risk decreased for patients with a one-level decrease (T1 1.1%, T2 0.9%, p < 0.01) or greater than or equal to two-level decrease (T1 2.5%, T2 1.4%, p < 0.001). Increases in AUDIT-C categories were not associated with increased risk of mental health acute care utilization. CONCLUSIONS: Changes in AUDIT-C score categories over time, particularly decreases, may reflect real changes in an important risk of UAU. Changes in alcohol screening scores may offer clinicians, health systems, and researchers meaningful information about changes in health risk.