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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 699 Research Studies DisplayedGertner AK, Grove LR, Swietek KE
Enhanced primary care for people with serious mental illness: a propensity weighted cohort study.
The objective of this propensity-weighted cohort study was to assess the effect of a new model of enhanced primary care for people with serious mental illness on cardiometabolic outcomes. Using electronic health data from a large academic medical system, researchers compared patients receiving enhanced primary care to patients receiving usual primary care. The researchers concluded that enhanced primary care can achieve clinically meaningful improvements in cardiometabolic health compared to usual primary care.
AHRQ-funded; HS000032.
Citation: Gertner AK, Grove LR, Swietek KE .
Enhanced primary care for people with serious mental illness: a propensity weighted cohort study.
J Clin Psychiatry 2023 Apr 5; 84(3). doi: 10.4088/JCP.22m14496..
Keywords: Primary Care, Behavioral Health, Patient-Centered Healthcare
Steiger KG, Boehmer KR, Klanderman MC
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
The objective of this study was to create a model based on patients' characteristics that predicted the number of burdens reported using the ICAN Discussion Aid, in order to target use of this tool to the patients most likely to benefit. Participants were 635 adult patients who completed the ICAN Aid at a Scottsdale, Arizona, family medicine clinic; patient characteristics were gathered from their health records. The results showed that the number of burdens a patient will report on the ICAN Aid can be approximated based on certain patient characteristics. Adults with major depression, a BMI of 26 or greater, and those of a younger age may have greater reported burdens on ICAN. The authors noted that these finding will need to be validated in independent samples.
AHRQ-funded; HS026379; HS026379.
Citation: Steiger KG, Boehmer KR, Klanderman MC .
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
J Am Board Fam Med 2023 Apr 3;36(2):277-88. doi: 10.3122/jabfm.2022.220251R1.
Keywords: Depression, Behavioral Health
Sibley AL, Baker R, Levander XA
"I am not a junkie": social categorization and differentiation among people who use drugs.
The purpose of this qualitative study, framed by Social Identity Theory/Self-Categorization Theory, was to investigate strategies of within-group categorization and differentiation among people who use drugs (PWUD) and the roles these social categories play in shaping intragroup attitudes, perceptions, and behaviors. Data were taken from the Rural Opioid Initiative. Through interviews with participating PWUDs, researchers identified several facets of identity, behavioral and demographic, along which PWUDs perceived salient social boundaries. Patterns of categorization and differentiation revealed negative intragroup attitudes, including stigma, that may hinder collective action in this marginalized group.
AHRQ-funded; HS026370.
Citation: Sibley AL, Baker R, Levander XA .
"I am not a junkie": social categorization and differentiation among people who use drugs.
Int J Drug Policy 2023 Apr;114:103999. doi: 10.1016/j.drugpo.2023.103999.
Keywords: Substance Abuse, Behavioral Health, Social Stigma
Goodsmith N, Dossett EC, Gitlin R
Acceptability of reproductive goals assessment in public mental health care.
The purpose of this study was to evaluate the perspectives of patients and clinicians on the feasibility of assessing reproductive objectives in public mental health facilities and provide insights for potential customization in these environments. The researchers analyzed primary qualitative data from clients and healthcare providers at four urban public mental health centers catering to individuals with persistent mental disorders (gathered between November 2020 and October 2021). This exploratory qualitative investigation involved female patients of reproductive age who spoke English and were predominantly Black or Latina, as well as mental health professionals (psychiatrists, therapists, case managers, nurses). The study focused on the acceptability of evaluating reproductive aspirations in mental health treatment and gathered input on two discussion guides for reproductive goals assessment: PATH (Pregnancy Attitudes, Timing, and Importance of Pregnancy Prevention) and OKQ (One Key Question). Semi-structured phone interviews were conducted with 22 patients and 36 healthcare providers. Rapid qualitative analysis was employed to summarize interview transcripts, and matrix analysis was used to identify themes. The study found that attitudes towards reproductive goals assessment were generally favorable. Clinicians believed that the discussion guides would "initiate" essential conversations, enhance comprehension of patients' objectives, and aid in medication guidance and planning. A small number of patients expressed unease or uncertainty; some recommended that providers seek permission or enable patients to introduce the subject. Additional themes encompassed the necessity for contextual framing to address personal inquiries, the importance of establishing rapport before posing questions, and the difficulty of managing multiple priorities. Several participants found both PATH and OKQ prompts acceptable; some favored the "dialogue-based" and "open-ended" phrasing of PATH.
AHRQ-funded; HS026407
Citation: Goodsmith N, Dossett EC, Gitlin R .
Acceptability of reproductive goals assessment in public mental health care.
Health Serv Res 2023 Apr;58(2):510-20. doi: 10.1111/1475-6773.14111.
Keywords: Behavioral Health, Women, Sexual Health
Lee AK, Bobb JF, Richards JE
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
This study’s goal was to evaluate an implementation intervention to increase (1) population-based alcohol-related prevention with brief interventions and (2) treatment of alcohol use disorder (AUD) in primary care implemented with a broader program of behavioral health integration. This stepped-wedge cluster randomized trial called the Sustained Patient-Centered Alcohol-Related Care (SPARC) trial included 22 primary care practices in an integrated health system in Washington state. Participants consisted of all adult patients 18 years or older with primary care visits from January 2015 to July 2018. The study included 7 waves, with practices randomly assigned launch dates. A total of 333,596 patients visited primary care (mean age, 48 years; 193,583 [58%] female; 234,764 [70%] White individuals). The proportion of patients with brief intervention was higher during SPARC intervention than usual care periods (57 vs 11 per 10,000 patients per month). The proportion with AUD treatment engagement did not differ during intervention and usual care. However, it did increase intermediate outcomes: screening (83.2% vs 20.8%), new AUD diagnosis (33.8 vs 28.8 per 10,000), and treatment initiation (7.8 vs 6.2 per 10,000).
AHRQ-funded; HS023173.
Citation: Lee AK, Bobb JF, Richards JE .
Integrating alcohol-related prevention and treatment into primary care: a cluster randomized implementation trial.
JAMA Intern Med 2023 Apr;183(4):319-28. doi: 10.1001/jamainternmed.2022.7083.
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Patient-Centered Healthcare
Goldstein E, King C, Crits-Cristoph P
The association between trauma and interpersonal problems in a United States community mental health setting.
Prior studies have established connections between traumatic experiences and issues in interpersonal relationships. The purpose of this study was to explore the influence of trauma on interpersonal difficulties in depressed individuals seeking assistance within a community mental health framework. The study included 453 patients who sought treatment and were screened for a comparative effectiveness analysis of depression therapies. The relationship between the 32-item Inventory of Interpersonal Problems (IIP-32) and trauma indicators was investigated. The study found that a staggering 99.1% of participants had undergone a traumatic event. Notable correlations were identified between the total count of traumas, the number of sexually and physically abusive traumas, and factors such as gender and ethnicity. The number of sexually abusive traumas demonstrated a significant connection to the IIP-32 "excessively nurturing" subscale. After adjusting for demographic variables and other IIP-32 subscales, the overall number of traumas retained a significant association with the IIP-32 "excessively nurturing" category.
AHRQ-funded; HS018440
Citation: Goldstein E, King C, Crits-Cristoph P .
The association between trauma and interpersonal problems in a United States community mental health setting.
J Clin Psychol 2023 Apr;79(4):1192-207. doi: 10.1002/jclp.23467.
Keywords: Trauma, Behavioral Health, Community-Based Practice
Wells KB, Skrine Jeffers K, Mango J
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
This case study describes development of an opera on veteran resilience and recovery that integrated arts and health sciences. The opera libretto was developed using themes informed from deidentified interviews from 280 adults with a history of depression at 10-year follow-up to a randomized trial. The opera was written using the following key themes: a) resilience in the face of stress; b) post-Vietnam depression or anxiety; c) pathways to recovery; and d) a “collage” of coping strategies. Three main lead characters were developed including a lead veteran, the veteran’s wife, and a second veteran.
AHRQ-funded; HS008349.
Citation: Wells KB, Skrine Jeffers K, Mango J .
Integration of arts and health sciences in developing an opera on veteran resilience and recovery.
Health Promot Pract 2023 Mar; 24(2):207-13. doi: 10.1177/15248399211065402..
Keywords: Social Stigma, Trauma, Behavioral Health
Short VL, Gannon M, Sood E
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
The objectives of this qualitative study were to gather in-depth information regarding maternal and clinician-reported factors that facilitate or hinder well-child care (WCC) engagement as well as information from mothers' experiences during WCC visits. Thirty mothers in treatment for parental opioid use disorder (OUD) and 13 clinicians working at a pediatric primary care clinic participated by completing one telephone session which involved a brief questionnaire followed by a semi-structured interview. Facilitators identified by mothers and clinicians, included continuity of care, addressing material needs, and clinician OUD training and knowledge. Barriers to WCC included: stigma toward mothers with OUD, gaps in basic parenting knowledge, competing specialized health care needs, and insufficient time to address concerns.
AHRQ-funded; HS027399.
Citation: Short VL, Gannon M, Sood E .
Opportunities to increase well-child care engagement for families affected by maternal opioid use disorder: perceptions of mothers and clinicians.
Acad Pediatr 2023 Mar;23(2):425-33. doi: 10.1016/j.acap.2022.07.013.
Keywords: Children/Adolescents, Family Health and History, Opioids, Substance Abuse, Behavioral Health, Caregiving, Patient and Family Engagement
Yasui M, Choi Y, Chin M
Parental socialization of mental health in Chinese American families: what parents say and do, and how youth make meaning.
This study explored youth-reported parental socialization of mental health within Chinese American families by examining focus group data from high school and college students. The findings indicated that parents responded to youth distress in culturally consonant ways; youth engaged in active interpretation of parental messages through cultural brokering, bridging the gap between their parents' messages and mainstream concepts of mental health and help-seeking. The authors concluded that these findings revealed the significant role of culture in parental mental health socialization in Chinese American families, and emphasized the need to integrate culturally specific understandings of mental health into future interventions for Asian American youth.
AHRQ-funded; HS023007.
Citation: Yasui M, Choi Y, Chin M .
Parental socialization of mental health in Chinese American families: what parents say and do, and how youth make meaning.
Fam Process 2023 Mar;62(1):319-35. doi: 10.1111/famp.12766.
Keywords: Behavioral Health, Racial and Ethnic Minorities, Family Health and History
Franco MI, Staab EM, Zhu M
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
Utilizing patient portals in a population health framework for depression screening presents a potentially effective method for proactively engaging and identifying individuals with depression. The purpose of this study was to evaluate the efficacy of a population health-based depression screening compared to in-clinic screening alone in detecting patients with depression. A practical clinical trial conducted at an urban, academic, tertiary care center's adult internal medicine outpatient clinic included a total of 2713 eligible adult patients due for depression screening with active portal accounts. Patients with known depression or bipolar disorder, and those who had been screened within the previous year were excluded. Participants were randomly allocated to receive either usual care (n = 1372) or population health care (n = 1341). In the usual care group, medical assistants screened patients during clinic visits. In the population health care group, patients were sent portal-based letters inviting them to complete an online screener, irrespective of appointment status. The Computerized Adaptive Test for Mental Health (CAT-MH™) was used for both in-clinic and portal-based screenings. The study found that the population health care group displayed a higher depression screening rate compared to the usual care group (43% (n = 578) vs. 33% (n = 459), p < 0.0001). Additionally, the rate of positive screens was greater in the population health care group than in the usual care group (10% (n = 58) vs. 4% (n = 17), p < 0.001).
AHRQ-funded; HS26151
Citation: Franco MI, Staab EM, Zhu M .
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
J Gen Intern Med 2023 Mar;38(4):857-64. doi: 10.1007/s11606-022-07779-9.
Keywords: Depression, Behavioral Health, Screening, Health Information Technology (HIT)
Cook RR, Foot C, Arah OA
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
The co-use of stimulants and opioids is increasing rapidly. Medications for opioid use disorder (MOUD) have demonstrated efficacy in randomized clinical trials (RCTs), but stimulant use may decrease the likelihood of initiating MOUD treatment. Moreover, trial participants may not represent "real-world" populations who would benefit from treatment. The study analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The study found that in RCTs, stimulant use reduced the likelihood of MOUD initiation by 32%. Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment and adults entering OUD treatment. The association was more pronounced, but still non-significant among rural people injecting drugs. Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population. The researchers concluded that stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, particularly among rural people injecting drugs, who already face limited access to MOUD.
AHRQ-funded; HS026370.
Citation: Cook RR, Foot C, Arah OA .
Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations.
Addict Sci Clin Pract 2023 Feb 14; 18(1):11. doi: 10.1186/s13722-023-00364-3..
Keywords: Substance Abuse, Behavioral Health, Opioids, Medication
Alexandre W, Muhammad H, Agbalajobi O
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
The purpose of this study was to investigate the relationships between medical dialogues concerning alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality rates. The retrospective cohort study encompassed all patients diagnosed with cirrhosis and AUD receiving hepatology care within a single healthcare system in 2015. Baseline data on demographics, medical history, liver disease, and AUD treatment were examined. Information on AUD treatment discussions, initiation, alcohol cessation, and the subsequent 5-year mortality rates was gathered. Out of 436 patients with alcohol-related cirrhosis, 15% received AUD treatment at baseline, with 11% undergoing behavioral therapy, 2% receiving pharmacotherapy, and 1% obtaining both. Within the first year after the initial hepatology visit, 37 patients had AUD treatment, 51 remained in treatment, and 14 discontinued. Hepatology-documented AUD treatment recommendations were provided to 30% of patients, while 26% received primary care-documented recommendations. The majority of hepatology (86%) and primary care (88%) recommendations focused on behavioral therapy. Among patients with persistent alcohol use at baseline, AUD treatment after one year was significantly and independently associated with hepatology or primary care treatment discussions, and negatively associated with Medicaid insurance. When treatment discussions occurred in both settings, high treatment rates followed. Over five years, 35% of patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma significantly contributed to mortality in the final survival model. In patients with alcohol-related cirrhosis, AUD treatment discussions were documented in fewer than half of hepatology and primary care encounters; however, such discussions were significantly correlated with AUD treatment receipt.
AHRQ-funded; HS019461.
Citation: Alexandre W, Muhammad H, Agbalajobi O .
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
BMC Gastroenterol 2023 Feb 2; 23(1):29. doi: 10.1186/s12876-023-02656-z..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Clinician-Patient Communication, Communication
Steenland MW, Trivedi AN
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
This study examined the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum. This cohort study used data comparing persons with Medicaid and commercially financed childbirth using Arkansas' All-Payer Claims Database (2013-2016). A total of 60,990 births were included, with 72% of births paid for by Medicaid and 28% paid by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point increase in the likelihood, or a relative change of 110%, in this outcome. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points and the number of days with antidepressant supply in the later postpartum period by 14.1 days.
AHRQ-funded; HS027464.
Citation: Steenland MW, Trivedi AN .
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
JAMA Health Forum 2023 Feb; 4(2):e225603. doi: 10.1001/jamahealthforum.2022.5603..
Keywords: Depression, Behavioral Health, Medicaid, Maternal Care, Women, Access to Care
Hale KL, Zalla LC, Scherer EM
Grandparenting activities and mental health in Northern Sri Lanka.
The role of grandparenting activities in mitigating social engagement and depressive symptoms in older adults is a growing area of research interest. However, the diversity in demographic characteristics and caregiving responsibilities pose challenges in its measurement. The purpose of this study was to pilot test a mechanism for assessing grandparenting activities in a sample of 79 grandparents (aged 55 and above) in Sri Lanka and examined the relationship between these activities and psychological discomfort. The researchers further investigated if the correlation was influenced by the grandparents' functional constraints. The study found a positive correlation between increased involvement in generative grandparenting activities and reduced psychological distress, with the association being more pronounced in grandparents with higher functional restrictions.
AHRQ-funded; HS000032.
Citation: Hale KL, Zalla LC, Scherer EM .
Grandparenting activities and mental health in Northern Sri Lanka.
J Intergener Relatsh 2023; 21(2):194-214. doi: 10.1080/15350770.2021.1991869..
Keywords: Caregiving, Behavioral Health, Elderly
Wolf RM, Hall M, Williams DJ
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
This study’s objective was to determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. The authors examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Of 29,834 included encounters, 12.6% had pharmacologic restraint use, with three hospitals the highest utilizers of all drug classes. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175. There were no significant differences in pharmacologic restraint use found in the hospital-level analysis.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
J Hosp Med 2023 Feb; 18(2):120-29. doi: 10.1002/jhm.13009..
Keywords: Children/Adolescents, Behavioral Health, Hospitals, Medication
Ali MM, McClellan C, Mutter R
AHRQ Author: McClellan C
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Using micro data from the National Survey on Drug Use and Health, researchers examined the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. They found that RML adoption reduced the likelihood of misusing prescription opioids; however, this initial effect appeared to dissipate 2 or 3 years after RML adoption, when the relationship to the likelihood of misusing prescription opioids became positive.
AHRQ-authored.
Citation: Ali MM, McClellan C, Mutter R .
Recreational marijuana laws and the misuse of prescription opioids: evidence from National Survey on Drug Use and Health microdata.
Health Econ 2023 Feb; 32(2):277-301. doi: 10.1002/hec.4620..
Keywords: Opioids, Medication, Substance Abuse, Behavioral Health, Policy
Crits-Christoph P, Gallop R, Duong L
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Keywords: Depression, Behavioral Health, Research Methodologies
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
AHRQ-funded; HS018440
Citation: Crits-Christoph P, Gallop R, Duong L .
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Psychother Res 2023 Feb;33(2):158-72. doi: 10.1080/10503307.2022.2073289.
Keywords: Depression, Behavioral Health, Research Methodologies
Westley L, Manworren RCB, Griffith DM
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
The purpose of this study was to quantify issues related to hospital incident command systems (HICS) implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic, and track progress toward HICS goals. The researchers analyzed data on patient census, nurse vacancies, staff injuries, and staff perceptions and resources were developed. The study found that after HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs.
AHRQ-funded; HS026385.
Citation: Westley L, Manworren RCB, Griffith DM .
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
J Nurs Adm 2023 Feb; 53(2):96-103. doi: 10.1097/nna.0000000000001254..
Keywords: COVID-19, Children/Adolescents, Behavioral Health, Hospitals
Moise N, Paniagua-Avila A, Barbecho JM
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
This study used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. The goal is to optimize depression treatment in primary care clinics using the Transform DepCare shared decision-making and psychoeducation patient tool. The authors applied the Behaviour Change Wheel to their prior mixed methods to identify key sustainability behaviors and determinants of sustainability. The authors enlisted 22 national and local stakeholders to operationalize and adapt a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. They identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. They determined that a waiting room that delivered DepCare, the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key improvements would include expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).
AHRQ-funded; HS025198.
Citation: Moise N, Paniagua-Avila A, Barbecho JM .
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
Implement Sci Commun 2023 Jan 25; 4(1):10. doi: 10.1186/s43058-022-00383-2..
Keywords: Depression, Primary Care, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Thompson KA, Hedlund EL, Sun Q
Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic.
The purpose of this study was to assess changes in and predictors of Eating Disorder (ED) symptoms, ED concerns related to the COVID-19 pandemic, and anxiety symptoms within the first 12 months of the COVID-19 pandemic among individuals with self-reported EDs in the United States, Sweden, and the Netherlands. The researchers administered an online survey to participants, evaluating ED symptoms, general anxiety symptoms, pandemic-related ED worries about accessing food, lack of structure and social support, being in a triggering environment, and costs of food and treatment. The study found that 3 patterns were evident: 1) a curvilinear progression with the greatest level of symptoms at baseline, declining through November 2020, and then increasing through the remainder of the year; 2) a linear declining progression; and 3) a stable progression with no variations. The researchers reported that concerns about COVID-19 infection, lockdown, worries about lack of structure and social support, and worries about accessing food aligned with their recovery meal plan predicted increases in ED symptoms.
AHRQ-funded.
Citation: Thompson KA, Hedlund EL, Sun Q .
Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic.
Int J Eat Disord 2023 Jan; 56(1):151-68. doi: 10.1002/eat.23870..
Keywords: COVID-19, Behavioral Health, Anxiety
Safon CB, Estela MG, Rosenberg J
Implementation of a novel pediatric behavioral health integration initiative.
The purpose of this concurrent, qualitative-dominant mixed methods empirical study was to explore healthcare professionals' perceptions of the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). The researchers utilized semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year process and surveys administered at three time points. Qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. The researchers round five emergent themes aligning with RC domains. The results of the survey showed that healthcare professionals reported both greater behavioral healthcare integration into clinic practice and greater clinic readiness to address behavioral health needs. The researchers concluded that effective pediatric BHI and care delivery at CHCs may depend on solid professional relationships and communication.
AHRQ-funded; HS022242.
Citation: Safon CB, Estela MG, Rosenberg J .
Implementation of a novel pediatric behavioral health integration initiative.
J Behav Health Serv Res 2023 Jan;50(1):1-17. doi: 10.1007/s11414-022-09803-6..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Primary Care, Patient-Centered Healthcare, Community-Based Practice
Goodsmith N, Cohen AN, Pedersen ER
Predictors of functioning and recovery among men and women veterans with schizophrenia.
This study examined predictors of functioning and recovery among men and women veterans with schizophrenia in treatment at Veterans Affairs medical centers using participant surveys at baseline and one year later. The cohort included 734 men and 67 women at baseline and 604 men and 58 women one year later. They were surveyed on quality of life and functioning. Men and women did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Being female predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Marriage predicted higher quality of life for women, but not for men.
AHRQ-funded; HS026407.
Citation: Goodsmith N, Cohen AN, Pedersen ER .
Predictors of functioning and recovery among men and women veterans with schizophrenia.
Community Ment Health J 2023 Jan; 59(1):110-21. doi: 10.1007/s10597-022-00979-x..
Keywords: Behavioral Health, Sex Factors
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
AHRQ-funded; HS027389.
Citation: Toseef MU, Durfee J, Podewils LJ .
Total cost of care associated with opioid use disorder treatment.
Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance