Association Between Assistance With Medicaid Enrollment and Use of Health Care After Incarceration Among Adults With a History of Substance Use.
Association Between Assistance With Medicaid Enrollment and Use of Health Care After Incarceration Among Adults With a History of Substance Use.
复制标题
DOI：
10.1001/jamanetworkopen.2021.42688
复制
发表时间：
2022-01-04
影响因子：
13.8
通讯作者：
Westergaard RP
中科院分区：
文献类型：
--
作者：
Burns ME;Cook S;Brown LM;Dague L;Tyska S;Hernandez Romero K;McNamara C;Westergaard RP
监狱医疗补助登记援助是否与有药物吸毒史的成年人在获释后30天内更多地使用医疗保健有关？在这项对16名 307人进行的队列研究中，发放前医疗补助登记援助的可用性与任何门诊就诊的可能性大幅绝对增加以及与物质使用相关的和基于医院的护理使用的绝对增加小幅或没有绝对增加相关。这项研究发现，在惩教环境中将医疗补助登记援助添加到出院计划中，与立即重新进入期间有物质使用障碍的个人的门诊医疗保健使用量增加有关。从监狱过渡到社区的特点是发病率和死亡率上升，特别是由于吸毒过量。然而，大多数以前被监禁的患有药物使用障碍的成年人在监禁后的最初几个月里没有使用任何医疗保健，包括治疗药物使用障碍。评估释放前的医疗补助登记援助计划是否与出狱后30天内增加的医疗保健使用有关。这项回顾性队列研究包括16名 307成年人，年龄在19岁至之间，有药物吸毒史，于2014年4月1日至2016年12月31日从国家监狱释放。威斯康星州惩教部于2015年1月实施了提前发放的医疗补助登记援助。统计分析时间为2021年1月1日至8月31日。全州范围内的医疗补助预发行登记援助计划。主要结果是医疗补助报销的医疗保健，与药物使用障碍和任何原因有关，在获释后30天内，包括门诊、急诊科和住院护理。使用意向治疗分析和威斯康星州惩教和医疗补助部门的个人水平数据，比较了在实施释放前医疗补助登记援助之前和之后发布的平均结果。样本包括16个 307人和18个 265合格释放(男性占18个 265释放总数的16个 320，18个 265释放中的6213个是黑人个人；释放时的平均[SD]年龄为35.5[10.7]岁)。与基线相比，在实施登记援助后30天内门诊就诊的可能性增加了7.7%(95%CI，6.4-8.9%；P <； .001)，阿片类药物使用障碍就诊增加了0.7个百分点(95%CI，0.4-1.0个百分点；P <； .001)，任何物质使用障碍就诊增加了1.0个百分点(95%CI，0.5-1.6个百分点；P <；( .001)，接受阿片类药物使用障碍药物治疗增加0.4个百分点(95%CI，0.2-0.6个百分点；P <； .001)。急诊科的使用没有显著变化(0.7个百分点[95%可信区间，-0.15至1.4个百分点])。住院概率增加了0.4个百分点(95%CI，0.03-0.7个百分点；P = .03)。这项队列研究的结果表明，释放前的医疗补助登记援助与监禁后更多地使用门诊医疗保健有关，并突出了在惩教环境中普遍提供这种援助的价值。可能需要更多量身定制的干预措施，以增加对药物使用障碍的治疗。这项队列研究评估了释放前的医疗补助登记援助计划是否与出狱后30天内医疗保健使用量的增加有关。
Is prison-based Medicaid enrollment assistance associated with increased use of health care within 30 days of prison release among adults with a history of substance use? In this cohort study of 16 307 individuals, the availability of prerelease Medicaid enrollment assistance was associated with large absolute increases in the likelihood of any outpatient visit and small or no absolute increases for substance use–associated and hospital-based care use. This study found that the addition of Medicaid enrollment assistance to discharge planning in correctional settings was associated with increased outpatient health care use for individuals with substance use disorders during the immediate reentry period. The transition from prison to community is characterized by elevated morbidity and mortality, particularly owing to drug overdose. However, most formerly incarcerated adults with substance use disorders do not use any health care, including treatment for substance use disorders, during the initial months after incarceration. To evaluate whether a prerelease Medicaid enrollment assistance program is associated with increased health care use within 30 days after release from prison. This retrospective cohort study included 16 307 adults aged 19 to 64 years with a history of substance use who were released from state prison between April 1, 2014, and December 31, 2016. The Wisconsin Department of Corrections implemented prerelease Medicaid enrollment assistance in January 2015. Statistical analysis was performed from January 1 to August 31, 2021. A statewide Medicaid prerelease enrollment assistance program. The main outcome was Medicaid-reimbursed health care, associated with substance use disorders and for any cause, within 30 days of prison release, including outpatient, emergency department, and inpatient care. Mean outcomes were compared for those released before and after implementation of prerelease Medicaid enrollment assistance using an intention-to-treat analysis and person-level data from the Wisconsin Department of Corrections and Medicaid. The sample included 16 307 individuals with 18 265 eligible releases (men accounted for 16 320 of 18 265 total releases, and 6213 of 18 265 releases were among Black individuals; mean [SD] age at release, 35.5 [10.7] years). The likelihood of outpatient care use within 30 days of release increased after implementation of enrollment assistance relative to baseline by 7.7 percentage points for any visit (95% CI, 6.4-8.9 percentage points; P < .001), by 0.7 percentage points for an opioid use disorder visit (95% CI, 0.4-1.0 percentage points; P < .001), by 1.0 percentage point for any substance use disorder visit (95% CI, 0.5-1.6 percentage points; P < .001), and by 0.4 percentage points for receipt of medication for opioid use disorder (95% CI, 0.2-0.6 percentage points; P < .001). There was no significant change in use of the emergency department (0.7 percentage points [95% CI, –0.15 to 1.4 percentage points]). The probability of an inpatient stay increased by 0.4 percentage points (95% CI, 0.03-0.7 percentage points; P = .03). The results of this cohort study suggest that prerelease Medicaid enrollment assistance was associated with increased use of outpatient health care after incarceration and highlights the value of making this assistance universally available within correctional settings. More tailored interventions may be needed to increase the receipt of treatment for substance use disorders. This cohort study evaluates whether a prerelease Medicaid enrollment assistance program was associated with increased health care use within 30 days after release from prison.
登录
查看更多内容
影响因子：
3.9
作者：
Gryczynski J;Schwartz RP;Salkever DS;Mitchell SG;Jaffe JH
通讯作者：
Jaffe JH
影响因子：
120.7
作者：
Chandler, Redonna K.;Fletcher, Bennett W.;Volkow, Nora D.
通讯作者：
Volkow, Nora D.
影响因子：
3.4
作者：
Burns, Marguerite E.;Cook, Steven T.;Westergaard, Ryan P.
通讯作者：
Westergaard, Ryan P.
阿片类药物过量或诊断为阿片类药物使用障碍后参加阿片类激动剂治疗的预测因素：一项队列研究。
影响因子：
4.2
作者：
Macmadu A;Paull K;Youssef R;Batthala S;Wilson KH;Samuels EA;Yedinak JL;Marshall BDL
通讯作者：
Marshall BDL
影响因子：
3.4
作者：
Friedmann, PD;Lemon, SC;D'Aunno, TA
通讯作者：
D'Aunno, TA