Haiyong Xu

Prevalence and Correlates of At-Risk Drinking Among Older Adults: The Project SHARE Study

ABSTRACTBACKGROUNDAt-risk drinking, excessive or potentially harmful alcohol use in combination with select comorbidities or medication use, affects about 10% of elderly adults and is associated with higher mortality. Yet, our knowledge is incomplete regarding the prevalence of different categories of at-risk drinking and their associations with patient demographics.OBJECTIVETo examine the prevalence and correlates of different categories of at-risk drinking among older adults.DESIGNCross-sectional analysis of survey data.SUBJECTSCurrent drinkers ages 60 and older accessing primary care clinics around Santa Barbara, California (n = 3,308).MEASUREMENTSAt-risk drinkers were identified using the Comorbidity Alcohol Risk Evaluation Tool (CARET). At-risk alcohol use was categorized as alcohol use in the setting of 1) high-risk comorbidities or 2) high-risk medication use, and 3) excessive alcohol use alone. Adjusted associations of participant characteristics with at-risk drinking in each of the three at-risk categories and with at-risk drinking of any kind were estimated using logistic regression.RESULTSOver one-third of our sample (34.7%) was at risk. Among at-risk individuals, 61.9% had alcohol use in the context of high-risk comorbidities, 61.0% had high-risk medication use, and 64.3% had high-risk alcohol behaviors. The adjusted odds of at-risk drinking of any kind were decreased and significant for women (odds ratio, OR = 0.41; 95% confidence interval: 0.35-0.48; p-value < 0.001), adults over age 80 (OR = 0.55; CI: 0.43-0.72; p < 0.001 vs. ages 60-64), Asians (OR = 0.40; CI: 0.20-0.80; p = 0.01 vs. Caucasians) and individuals with higher education levels. Similar associations were observed in all three categories of at-risk drinking.CONCLUSIONSHigh-risk alcohol use was common among older adults in this large sample of primary care patients, and male Caucasians, those ages 60-64, and those with lower levels of education were most likely to have high-risk alcohol use of any type. Our findings could help physicians identify older patients at increased risk for problems from alcohol consumption.

Correlates of Alcohol‐Related Discussions Between Older Adults and Their Physicians

OBJECTIVES: To identify predictors of alcohol‐related patient–physician discussions.

Effect of medicare part D benzodiazepine exclusion on psychotropic use in benzodiazepine users.

To evaluate the effect of the Medicare benzodiazepine coverage exclusion on psychotropic use of benzodiazepine users.

Personality disorders and body weight

We examine the impact of Axis II personality disorders (PDs) on body weight. PDs are psychiatric conditions that develop early in life from a mixture of genetics and environment, are persistent, and lead to substantial dysfunction for the affected individual. The defining characteristics of PDs conceptually link them with body weight, but the direction of the relationship likely varies across PD type. To investigate these links, we analyze data from Wave II of the National Epidemiological Survey of Alcohol and Related Conditions. We measure body weight with the body mass index (BMI) and a dichotomous indicator for obesity (BMI≥30). We find that women with PDs have significantly higher BMI and are more likely to be obese than otherwise similar women. We find few statistically significant or economically meaningful effects for men. Paranoid, schizotypal, and avoidant PDs demonstrate the strongest adverse impacts on womens body weight while dependent PD may be protective against elevated body weight among men. Findings from unconditional quantile regressions demonstrate a positive gradient between PDs and BMI in that the effects are greater for higher BMI respondents.

Medicare Part D Benzodiazepine Exclusion and Use of Psychotropic Medication by Patients With New Anxiety Disorders

OBJECTIVE The Medicare Modernization Act (MMA) specifically excluded benzodiazepines from Medicare Part D coverage starting in 2006; however, benzodiazepines are an effective, low-cost treatment for anxiety. This study evaluated the effect of the Medicare Part D benzodiazepine coverage exclusion among patients with new anxiety disorders. METHODS The authors used a quasi-experimental cohort design to study patients with new anxiety diagnoses from a large national health plan during the first six months of 2005, 2006, and 2007. Logistic and zero-truncated negative-binomial regression models using covered claims for behavioral, medical, and pharmaceutical care linked with eligibility files were used to estimate utilization and costs of psychotropic medication and health care utilization among elderly Medicare Advantage enrollees (N=8,397) subject to the MMA benzodiazepine exclusion and a comparison group of near-elderly (ages 60–64) enrollees (N=1,657) of a managed care plan. RESULTS Medicare Advantage enrollees diagnosed in 2005 had significantly (p<.05) higher rates of covered claims for benzodiazepines and all psychotropic drugs, lower rates of covered claims for nonbenzodiazepines, and lower expenditures for psychotropic drugs than enrollees diagnosed in 2006 and 2007. There were no significant differences over time in utilization or expenditures related to psychotropic medication among the comparison group. There also were no significant changes over time in outpatient visits for behavioral care by either cohort. CONCLUSIONS Among elderly patients with new anxiety diagnoses, the MMA benzodiazepine exclusion increased use of nonbenzodiazepine psychotropic drugs without substitution of increased behavioral care. Overall, the exclusion was associated with a modest increase in covered claims for psychotropic medication.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

Objective: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA’s impact on BH expenditures and utilization among “carve-in” enrollees. Methods: We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008–2009), during (2010), and after (2011–2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. Results: MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of:

Mental Health and High‐Cost Health Care Utilization: New Evidence from Axis II Disorders

1.05 (P=0.02);

At‐Risk Drinking and Outpatient Healthcare Expenditures in Older Adults

0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. Conclusions: MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was

The Effect of a Patient–Provider Educational Intervention to Reduce At-Risk Drinking on Changes in Health and Health-Related Quality of Life Among Older Adults: The Project SHARE Study

4.92 without MHPAEA and

Disparities in Receipt of Specialty Services Among Children With Mental Health Need Enrolled in the CMHI

6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.