Cargando…
Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings
INTRODUCTION: This nationwide study builds on prior research, which suggests that Federally Qualified Health Centers (FQHCs) and other primary care providers are associated with increased access to opioid use disorder (OUD) treatment. We compare health care utilization, spending, and quality for Med...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578596/ https://www.ncbi.nlm.nih.gov/pubmed/36256662 http://dx.doi.org/10.1371/journal.pone.0276066 |
_version_ | 1784811996490760192 |
---|---|
author | Peterson, Lauren Murugesan, Manoradhan Nocon, Robert Hoang, Hank Bolton, Joshua Laiteerapong, Neda Pollack, Harold Marsh, Jeanne |
author_facet | Peterson, Lauren Murugesan, Manoradhan Nocon, Robert Hoang, Hank Bolton, Joshua Laiteerapong, Neda Pollack, Harold Marsh, Jeanne |
author_sort | Peterson, Lauren |
collection | PubMed |
description | INTRODUCTION: This nationwide study builds on prior research, which suggests that Federally Qualified Health Centers (FQHCs) and other primary care providers are associated with increased access to opioid use disorder (OUD) treatment. We compare health care utilization, spending, and quality for Medicaid patients diagnosed with OUD who receive primary care at FQHCs and Medicaid patients who receive most primary care in other settings, such as physician offices (non-FQHCs). We hypothesized that the integrated care model of FQHCs would be associated with greater access to medication for opioid use disorder (MOUD) and/or behavioral health therapy and lower rates of potentially inappropriate co-prescribing. METHODS: This cross-sectional study examined 2012 Medicaid Analytic eXtract files for patients diagnosed with OUD receiving most (>50%) primary care at FQHCs (N = 37,142) versus non-FQHCs (N = 196,712) in all 50 states and Washington DC. We used propensity score overlap weighting to adjust for measurable confounding between patients who received care at FQHCs versus non-FQHCs and increase generalizability of findings given variation in Medicaid programs and substance use policies across states. RESULTS: FQHC patients displayed higher primary care utilization and fee-for-service spending, and similar or lower utilization and fee-for-service spending for other health service categories. Contrary to our hypotheses, non-FQHC patients were more likely to receive timely (≤90 days) MOUD (buprenorphine, methadone, naltrexone, or suboxone) (Relative Risk [RR] = 1.10, 95% CI: 1.07, 1.12) and more likely be retained in medication treatment (>180 days) (RR = 1.12, 95% CI: 1.09, 1.14). However, non-FQHC patients were less likely to receive behavioral health therapy (mental health or substance use therapy) (RR = 0.90, 95% CI: 0.88, 0.92) and less likely to remain in behavioral health treatment (RR = 0.92, 95% CI: 0.89, 0.94). Non-FQHC patients were more likely to fill potentially inappropriate prescriptions of benzodiazepines and opioids after OUD diagnosis (RR = 1.35, 95% CI: 1.30, 1.40). CONCLUSIONS: Observed patterns suggest that Medicaid patients diagnosed with OUD who obtained primary care at FQHCs received more integrated care compared to non-FQHC patients. Greater care integration may be associated with increased access to behavioral health therapy and quality of care (lower potentially inappropriate co-prescribing) but not necessarily greater access to MOUD. |
format | Online Article Text |
id | pubmed-9578596 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-95785962022-10-19 Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings Peterson, Lauren Murugesan, Manoradhan Nocon, Robert Hoang, Hank Bolton, Joshua Laiteerapong, Neda Pollack, Harold Marsh, Jeanne PLoS One Research Article INTRODUCTION: This nationwide study builds on prior research, which suggests that Federally Qualified Health Centers (FQHCs) and other primary care providers are associated with increased access to opioid use disorder (OUD) treatment. We compare health care utilization, spending, and quality for Medicaid patients diagnosed with OUD who receive primary care at FQHCs and Medicaid patients who receive most primary care in other settings, such as physician offices (non-FQHCs). We hypothesized that the integrated care model of FQHCs would be associated with greater access to medication for opioid use disorder (MOUD) and/or behavioral health therapy and lower rates of potentially inappropriate co-prescribing. METHODS: This cross-sectional study examined 2012 Medicaid Analytic eXtract files for patients diagnosed with OUD receiving most (>50%) primary care at FQHCs (N = 37,142) versus non-FQHCs (N = 196,712) in all 50 states and Washington DC. We used propensity score overlap weighting to adjust for measurable confounding between patients who received care at FQHCs versus non-FQHCs and increase generalizability of findings given variation in Medicaid programs and substance use policies across states. RESULTS: FQHC patients displayed higher primary care utilization and fee-for-service spending, and similar or lower utilization and fee-for-service spending for other health service categories. Contrary to our hypotheses, non-FQHC patients were more likely to receive timely (≤90 days) MOUD (buprenorphine, methadone, naltrexone, or suboxone) (Relative Risk [RR] = 1.10, 95% CI: 1.07, 1.12) and more likely be retained in medication treatment (>180 days) (RR = 1.12, 95% CI: 1.09, 1.14). However, non-FQHC patients were less likely to receive behavioral health therapy (mental health or substance use therapy) (RR = 0.90, 95% CI: 0.88, 0.92) and less likely to remain in behavioral health treatment (RR = 0.92, 95% CI: 0.89, 0.94). Non-FQHC patients were more likely to fill potentially inappropriate prescriptions of benzodiazepines and opioids after OUD diagnosis (RR = 1.35, 95% CI: 1.30, 1.40). CONCLUSIONS: Observed patterns suggest that Medicaid patients diagnosed with OUD who obtained primary care at FQHCs received more integrated care compared to non-FQHC patients. Greater care integration may be associated with increased access to behavioral health therapy and quality of care (lower potentially inappropriate co-prescribing) but not necessarily greater access to MOUD. Public Library of Science 2022-10-18 /pmc/articles/PMC9578596/ /pubmed/36256662 http://dx.doi.org/10.1371/journal.pone.0276066 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Peterson, Lauren Murugesan, Manoradhan Nocon, Robert Hoang, Hank Bolton, Joshua Laiteerapong, Neda Pollack, Harold Marsh, Jeanne Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title | Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title_full | Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title_fullStr | Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title_full_unstemmed | Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title_short | Health care use and spending for Medicaid patients diagnosed with opioid use disorder receiving primary care in Federally Qualified Health Centers and other primary care settings |
title_sort | health care use and spending for medicaid patients diagnosed with opioid use disorder receiving primary care in federally qualified health centers and other primary care settings |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9578596/ https://www.ncbi.nlm.nih.gov/pubmed/36256662 http://dx.doi.org/10.1371/journal.pone.0276066 |
work_keys_str_mv | AT petersonlauren healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT murugesanmanoradhan healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT noconrobert healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT hoanghank healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT boltonjoshua healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT laiteerapongneda healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT pollackharold healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings AT marshjeanne healthcareuseandspendingformedicaidpatientsdiagnosedwithopioidusedisorderreceivingprimarycareinfederallyqualifiedhealthcentersandotherprimarycaresettings |