Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study

Yang, Bo; Idzik, Shannon; Evans, Paige K.

doi:10.1016/j.ijnurstu.2021.103956

Cited by 6 publications

(9 citation statements)

References 40 publications

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“…Canada is not alone in its approach to measuring mental health related service contacts among children and youth. Evidence from other nations, including the United States, United Kingdom, and Denmark also relies heavily on estimates derived from either survey or administrative/registry data with varying levels of service coverage and measurement of socio-demographic characteristics and factors related to mental health need [ 16 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

Edwards

Wang

Duncan

et al. 2022

Child Adolesc Psychiatry Ment Health

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Background To inform the provision and organization of care, and to improve equitable access to mental health services for children and youth, we must first characterize the children and youth being served, taking into consideration factors related to mental health need. Our objective was to use a population-based survey linked with health administrative data to estimate mental health related contacts and determine socio-demographic correlates, after adjusting for factors related to mental health need. Methods Data from the 2014 Ontario Child Health Study (OCHS) were linked at the individual level to health administrative databases from Ontario’s Ministry of Health and Long-Term Care (MOHLTC). Mental health related service contacts were identified in the 6-months prior to the OCHS survey date. Service contacts with physicians were obtained from health administrative data, and non-physician service contacts from survey data (parent-report). Results 21.7% of Ontarian children (4–11 years) and youth (12–17 years) had at least one mental health related contact in the 6-months prior to their OCHS survey date (18.8% non-physician, 8.0% physician, 5.2% both). Children and youth contacting both physician and non-physician services (ref. contact with physician or non-physician services alone) had higher mean symptom ratings of mental disorders across all classes of disorder. After adjusting for total symptom ratings, children and youth with immigrant parent(s) (ref. non-immigrant) (Prevalence Ratio: 0.65, 95% CI 0.55, 0.75) were less likely to have any mental health related service contact. Conclusions Results indicate that children and youth with the highest mental health symptom ratings are more likely to have contact with multiple providers across sectors. As such, the coordination of care across and within sectors are critical components of mental health related services for children and youth. Our results indicate that the greatest disparities in mental health related service contacts may exist for children and youth with immigrant parent(s) and that targeted outreach efforts are required to reduce barriers to care and improve equitable access to mental health related services for children and youth in Ontario.

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Section: Introductionmentioning

confidence: 99%

Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

Edwards

Wang

Duncan

et al. 2022

Child Adolesc Psychiatry Ment Health

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“…Based on the MH service use literature, [10][11][12][13][14][15][16][17][18][19][20][21][22] variables used to construct profiles of patients based on outpatient follow-up care included: having a family doctor; frequency of consultations with a usual patient general practitioner (GP) or outpatient psychiatrist; usual physician provider (GP or psychiatrist only, both GP and psychiatrist, or neither); high continuity of medical care; number of psychosocial interventions in community healthcare centers, measured from the index ED visit for a 12-month period; at least one medical consultation (GP or psychiatrist) within 30 days, 2 medical consultations within 90 days, or 5 medical consultations within 365 days following index ED visit (2 consultations in the first 90 days, and 3 between 91 and 365 days) (Figure 1). Usual patient GP, a proxy for a family doctor, was defined as having a minimum of 2 consultations with the same GP or with at least 2 GP working in the same family medicine group.…”

Section: Variablesmentioning

confidence: 99%

“…14,15 One study distinguished 3 classes of patients according to low, moderate, or high use of MH services, 16 while 2 other studies identified classes related to intensity and diversity of care for MH reasons. 17,18 Moreover, few studies have linked profiles of patients based on follow-up care with sociodemographic and clinical characteristics. Younger age, 12,19 single civil status, 20 and diagnoses of common MD or substance-related disorder (SRD) 11,21 were associated with lower continuity and less adequate care, compared with older age, serious MD, and having social support.…”

Section: Introductionmentioning

confidence: 99%

Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits

2022

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Objective This 5-year longitudinal study evaluated patients with an onset of mental disorder (MD) following index emergency department (ED) visits, in terms of (1) patient profiles based on 12-month outpatient follow-up care received, (2) sociodemographic and clinical correlates, and (3) adverse health outcomes for the subsequent 2 years. Methods Data from administrative databases were collected for 2541 patients with an onset of MD, following discharge from Quebec ED. Latent class analysis was performed to identify patient profiles based on the adequacy of follow-up care after ED discharge. Bivariate analyses examined associations between class membership and sociodemographic and clinical correlates, high ED use (3 + visits/yearly), hospitalizations, and suicidal behaviors. Results Five classes of patients were identified. Class 1, the smallest, labeled “patient psychiatrist only,” included mainly young patients with serious MD. Classes 2 and 3, roughly 20%, were labeled “high use of patient general practitioner (GP) and psychiatrist” and “low use of patient GP and psychiatrist,” respectively. Both included patients with complex MD, but Class 2 had more women and older patients with chronic physical illnesses. The 2 largest classes were labeled “no usual patient service provider” (Class 5) and “patient GP only” (Class 4). Class 5 included more younger men with substance-related disorders, while Class 4 had the older patients living in rural areas, many with common MD and chronic physical illnesses. Class 3 patients had the poorest outcomes, followed by Classes 1 and 2, while Classes 4 and 5 had the best outcomes. Conclusions Results revealed that nearly 40% of patients experiencing an onset of MD received little or no outpatient care following ED discharge. Higher severity or complexity of MD and, to a lesser extent, no or low GP follow-up may explain these adverse outcomes. More adequate, continuous care, including collaborative care, is needed for these vulnerable, high-needs patients.

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“…This is particularly important in rural communities and other disadvantaged communities where in general, APRNs provide a larger fraction of care compared to other communities 21,22 . The availability of such a methodology could also improve research on disparities in mental health treatment, the quality of mental health care delivery, or the clinical relationships between behavioral health APRNs and other behavioral health providers 12–18 …”

Section: Introductionmentioning

confidence: 99%

A methodology for identifying behavioral health advanced practice registered nurses in administrative claims

Richard

Huskamp

Barnett

et al. 2022

Health Services Research

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Objective (Study Question): Advanced practice registered nurses (APRNs) play an increased role in mental illness treatment. Health services research that uses claims to study mental health is often limited because behavioral health nurse practitioners (i.e., APRNs who specialize in mental illness, also known as psychiatric mental health APRNs) cannot be easily identified in claims data. We describe two methodologies to identify behavioral health APRNs in administrative claims.

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Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study

Cited by 6 publications

References 40 publications

Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data

Profiles, Correlates and Outcomes Among Patients Experiencing an Onset of Mental Disorder Based on Outpatient Care Received Following Index Emergency Department Visits

A methodology for identifying behavioral health advanced practice registered nurses in administrative claims

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