Kay Miller

Use of Mental Health and Substance Abuse Services Among High-Cost Medicaid Enrollees

Users of mental health and substance abuse (MH/SA) services were examined among nonelderly high-cost Medicaid enrollees in 10 states in 1995. Although MH/SA service users constitute 11% of all Medicaid enrollees, they make up nearly a third of high-cost enrollees. Adults account for two thirds of this high-cost MH/SA group, and most frequently qualify for Medicaid through disability-related eligibility categories. In contrast, a majority of children in the high-cost MH/SA group are eligible for Medicaid through child-related categories, rather than disability. In diagnostic makeup, the high-cost group was somewhat more likely to have serious disorders than the general Medicaid MH/SA user population.

Treatment with Antidepressant Medications in Private Health Plans

This study analyzed 2002 MarketScan data from a convenience sample of enrollees with private health insurance from the largest U.S. firms to examine utilization, expenditures, and factors associated with antidepressant prescriptions. Of enrollees, 11% received at least one antidepressant prescription during the year with average expenditures per enrollee of

Establishing the feasibility of measuring performance in use of addiction pharmacotherapy.

51.55. Antidepressant prescriptions were more frequently used than any form of other mental health care and for 42% of users was not associated with any clearly identified mental health or “off-label” indication. In logistical regression analyses, health plan type, prescription days supply, gender, region, age, employment status, and subscriber status were associated with unexplained antidepressant prescription use.

Psychiatric and medical comorbidities, associated pain, and health care utilization of patients prescribed buprenorphine.

This paper presents the rationale and feasibility of standardized performance measures for use of pharmacotherapy in the treatment of substance use disorders (SUD), an evidence-based practice and critical component of treatment that is often underused. These measures have been developed and specified by the Washington Circle, to measure treatment of alcohol and opioid dependence with FDA-approved prescription medications for use in office-based general health and addiction specialty care. Measures were pilot tested in private health plans, the Veterans Health Administration (VHA), and Medicaid. Testing revealed that use of standardized measures using administrative data for overall use and initiation of SUD pharmacotherapy is feasible and practical. Prevalence of diagnoses and use of pharmacotherapy vary widely across health systems. Pharmacotherapy is generally used in a limited portion of those for whom it might be indicated. An important methodological point is that results are sensitive to specifications, so that standardization is critical to measuring performance across systems.

Effect of direct-to-consumer advertising on asthma medication sales and healthcare use

This study describes the comorbidities and health care utilization of individuals treated with buprenorphine using the 2007-2009 MarketScan Research Databases. Buprenorphine recipients had a high prevalence of comorbidities associated with chronic pain, including back problems (42%), connective tissue disease (24-27%), and nontraumatic joint disorders (20-23%). Approximately 69% of recipients filled prescriptions for opioid agonist medications in the 6 months before buprenorphine initiation. Buprenorphine recipients were frequently diagnosed with anxiety (23-42%) and mood disorders (39-51%) and filled prescriptions for antidepressants (47-56%) and benzodiazepines (47-56%) at high rates. Surprisingly, only 53-54% of patients filling a prescription for buprenorphine had a coded opioid abuse/dependence diagnosis. Research is needed to better understand buprenorphines effectiveness in the context of prescription drug abuse and the best way to coordinate services to address the patients comorbid addiction, pain, and psychiatric illnesses.

Healthcare utilization of individuals with opiate use disorders: an analysis of integrated medicaid and state mental health/substance abuse agency data.

RATIONALE The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects. OBJECTIVES To quantify the association between asthma-related DTCA, pharmacy sales, and healthcare use. METHODS This was an ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales), and the MarketScan Commercial Claims data (healthcare use) for 75 designated market areas in the United States. We used multilevel Poisson regression to model the relationship between DTCA and rates of prescriptions and use within and across designated market areas. Main outcome measures include (1) volume of total, new, and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department use, (4) hospitalizations, and (5) outpatient encounters among the commercially insured. MEASUREMENTS AND MAIN RESULTS Four Food and Drug Administration-approved asthma medicines were advertised during the period examined: (1) fluticasone/salmeterol (Advair), (2) mometasone furoate (Asmanex), (3) montelukast (Singulair), and (4) budesonide/formoterol (Symbicort). After adjustment, each additional televised advertisement was associated with 2% (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.03) higher pharmacy sales rate from 2005 through 2009, although this effect varied across the three consistently advertised therapies examined. Among the commercially insured, DTCA was positively and significantly associated with emergency room visits related to asthma (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.04), but there was no relationship with hospitalizations or outpatient encounters. CONCLUSIONS Among this population, DTCA was associated with higher prescription sales and asthma-related emergency department use.

Prevalence and screening for anaemia in mild to moderate Crohn's disease and ulcerative colitis in the United States, 2010–2014

Data from the Substance Abuse and Mental Health Services Administration’s Integrated Database (IDB) were used to examine the service use patterns of individuals with possible opiate use disorders in Washington State. Results indicate that regardless of Medicaid enrollment status, individuals who received mental health (MH) or substance abuse (SA) services only through state agencies received no inpatient substance abuse service. Furthermore, when compared with individuals who received at least one MH/SA service through Medicaid, those who received services only through the state agencies were less likely to have received any MH services and were more likely to have received residential SA services. This analysis highlights the importance of using integrated client data in providing a more comprehensive understanding of services to inform policy and raises significant questions about how regulatory requirements affecting different funding mechanisms might drive settings of care in ways not related to the care needed.

Prevalence and Costs of Major Depression Among Elderly Claimants With Diabetes

Background and aims Anaemia affects up to 74% patients with Crohns disease (CD) and ulcerative colitis (UC) and is correlated with decreased quality of life. The European Crohns and Colitis Organisation (ECCO) recommends at least annual screening for iron-deficiency anaemia. We aimed to determine the prevalence of anaemia, frequency of anaemia screening and factors associated with anaemia in a retrospective study of mild to moderate inflammatory bowel disease (IBD) in the USA. Methods Adults with at least two outpatient encounters for IBD between 2010 through 2014 who contributed laboratory information were identified from MarketScan, a US commercial claims database. Hospitalised patients were considered severe and excluded from the study. WHO criteria defined anaemia. Iron-deficiency anaemia was evaluated using ferritin and C reactive protein. Results The eligible population included 17 059 adults, 43.9% with CD. During the 2-year median follow-up period, 68.1% of patients with CD and 65.3% of patients with UC were screened for anaemia. The prevalence of anaemia among those screened was 32.4% in CD and 27.6% in UC. Among 669 persons with sufficient information, 79.2% of those with CD and 85.1% of those with UC had iron-deficiency anaemia. Factors associated with anaemia were similar for those with CD and UC and included ≥6 IBD-related outpatient visits, female sex, age and smoking. Conclusions More than 30% of patients with IBD in the USA were not screened for anaemia during a 2-year period. Approximately 82% of anaemic patients were iron deficient, although the absence of ferritin results limited the findings. Incorporation of screening for anaemia and, in particular, iron deficiency, should be a component of international treatment guidelines.