Geographic Variation in the Supply of Selected Behavioral Health Providers

Andrilla, C. Holly A.; Patterson, Davis G.; Garberson, Lisa A.; Coulthard, Cynthia; Larson, Eric

doi:10.1016/j.amepre.2018.01.004

Cited by 310 publications

(244 citation statements)

References 22 publications

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“…In the United States, as mentioned above, the threshold for hospitalization is high, and the number of available beds has fallen over time (Blanz and Schmidt 2000;Cummings et al 2016). Most communities are woefully underresourced to meet youth mental health needs (Saxena et al 2007;Andrilla et al 2018;Findling and Stepanova 2018). Consequently, the youth served on our acute unit-and others like it-may be more severely ill than those treated in other countries that have nationalized health care and better access to services (Ridic et al 2012;Dixit and Sambasivan 2018).…”

Section: Prn Use In Adolescents 253mentioning

confidence: 99%

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Saito

Eng

Grosso

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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Objective: Evidence to support the use of pro re nata (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. Methods: A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Results: Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Conclusion: Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.

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Section: Prn Use In Adolescents 253mentioning

confidence: 99%

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Saito

Eng

Grosso

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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“…In the US, 27%, 35%, and 80% of metropolitan, micropolitan, and non-core (i.e. the most rural) counties, respectively, lack a psychiatrist [63]. Similar trends in shortages exist for psychologists and psychiatric nurse practitioners.…”

Section: Driving Forcesmentioning

confidence: 93%

“…Across all geographic areas, metropolitan counties (on average) in only five of the nine (5/9) geographic census regions met benchmarks for the ideal number of behavioral health providers needed per 100,000 adults. For micropolitan counties, this ratio was 1/9 census regions meeting provider benchmarks, and 0/9 for non-core counties [63]. Lower income or poverty are risk factors for both increased depression and reduced access to or utilization of care, which represents a complex paradox for delivering effective care in both rural and urban environments.…”

Section: Driving Forcesmentioning

confidence: 99%

Rising US Suicides: Achieving Health Equity

Perry¹,

Allison²,

Bastiampillai³

et al. 2019

Preprint

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Evidence suggests that increased availability of mental health treatment has not significantly reduced depression prevalence and suicide in the US, and that significant personal (i.e., stigma) or practical/logistical barriers to effective mental health care remain. Mental health treatment has increased in the US since the early 1990s with greater use of antidepressant medications, especially SSRIs, however suicide rates continue to climb, with significant gender, ethnic, geographic, socioeconomic, and other health disparities. Depression rates are at best stable, but are increasing in certain subpopulations such as youths ages 12-17. Combating these distressing trends to achieve health equity will require more attention to promising and evidence-based, sustainable, proactive, practical solutions that address the varied causes, demographics, and differential risk factors and mechanisms of suicide deaths. Herein we explore sociodemographic disparities that exist in suicide deaths, with emphasis on two of the largest modifiable targets for suicide prevention: untreated or undertreated depression, and access to the lethal means (firearms) that cause more suicide deaths than all other means combined, and thus pose the greatest threat to individual and public health. Furthermore, we newly define increased or unsafe (i.e. disparate) access to firearms as a suicide health disparity that promotes health inequities. To achieve the greatest results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs shown to reduce suicidal behaviors, and 2) enhanced focus on the two largest modifiable targets for suicide prevention: depression and firearms.

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“…The number of Opioid Treatment Programs (OTPs), in which methadone is provided for OUD, has remained relatively at over time (13,14). Many states have fewer than 10 OTPs, facilities that are scarce in rural areas (16)(17)(18). In 2002, physicians became eligible to prescribe buprenorphine for OUD in non-specialty settings, provided they complete requisite training and obtain a buprenorphine waiver from the Drug Enforcement Administration (DEA) (19).…”

Section: Access To Treatment For Opioid Use Disordermentioning

confidence: 99%

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder 

Haffajee

Andraka‐Christou

Attermann

et al. 2020

Preprint

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Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD. Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

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Geographic Variation in the Supply of Selected Behavioral Health Providers

Cited by 310 publications

References 22 publications

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Rising US Suicides: Achieving Health Equity

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder

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Geographic Variation in the Supply of Selected Behavioral Health Providers

Cited by 310 publications

References 22 publications

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Pro Re NataMedication Use in Acute Care Adolescent Psychiatric Unit

Rising US Suicides: Achieving Health Equity

A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder&nbsp;

Contact Info

Product

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A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder