Treatment for co-occurring mental and substance use disorders in five state Medicaid programs
Treatment for co-occurring mental and substance use disorders in five state Medicaid programs
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DOI：
10.1176/appi.ps.58.7.942
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发表时间：
2007-07-01
影响因子：
3.8
通讯作者：
McGovern, Mark P.
中科院分区：
文献类型：
--
作者：
Clark, Robin E.;Samnaliev, Mihail;McGovern, Mark P.
目的：这项研究描述了在五个州，患有精神和物质使用障碍的医疗补助受益人的精神和物质滥用治疗的地点和模式。方法：将21至65岁患有精神或药物使用障碍的医疗补助受益人与索赔和遭遇记录进行鉴定。小组进一步被分为有物质使用障碍和没有被诊断为物质使用障碍的人。调整后在社区环境、住院设施、急诊科和医院门诊部接受治疗的几率被计算出来。结果：共有92,355人患有精神障碍，34,158人患有药物使用障碍，14,256人同时患有精神障碍和物质使用障碍。在所有五个州，与那些单独患有严重精神疾病的人相比，患有严重精神疾病(精神分裂症、躁郁症或严重抑郁症)和药物使用障碍的受益人接受住院、急诊科和医院门诊精神治疗的几率更高。在五个州中的四个州，与单独患有精神疾病的人相比，严重和不严重的精神疾病以及共同发生的物质使用障碍与以社区为基础的治疗的几率较低有关。与那些单独患有不那么严重的精神疾病的人相比，患有不那么严重的精神障碍和同时存在物质使用障碍的人在所有州都有更高的住院治疗几率，在五个州中有三个州使用急诊科的几率更高。在大多数州，患有严重精神疾病和共生物质使用障碍的人住院和门诊使用以及急诊科治疗物质滥用的几率较高，而仅有物质使用障碍的人的几率较高。结论：医疗补助受益人大量使用住院和急诊科并伴有物质使用障碍是一个一贯的跨州问题。共生障碍可能会降低那些患有不太严重的精神障碍的人和那些患有严重精神疾病的人进行社区治疗的可能性，这表明只关注这些环境的政策可能会错过很大一部分患有这些共生障碍的人。
Objectives: This study described the locations and patterns of psychiatric and substance abuse treatment for Medicaid beneficiaries with co-occurring mental and substance use disorders in five states. Methods: Medicaid beneficiaries aged 21 to 65 with psychiatric or substance use disorders were identified with claims and encounter records. Groups were further divided into those with and those without a diagnosed substance use disorder. Adjusted odds of treatment in community-based settings, inpatient facilities, emergency departments, and hospital outpatient departments were calculated. Results: A total of 92,355 persons had a psychiatric disorder, 34,158 had a substance use disorder, and 14,256 had co-occurring psychiatric and substance use disorders. In all five states, beneficiaries with severe mental illness (schizophrenia, bipolar disorder, or major depression) and a substance use disorder had higher odds of inpatient, emergency department, and hospital-based outpatient psychiatric treatment, compared with those with severe mental illness alone. In four of five states, both severe and less severe mental illness and a co-occurring substance use disorder were associated with lower odds of community-based treatment compared with those with the respective mental illness alone. Compared with those with less severe mental illness alone, individuals with less severe psychiatric disorders and a co-occurring substance use disorder had higher odds of inpatient treatment in all states and of emergency department use in three of five states. Odds of inpatient and outpatient hospital use and emergency department use for substance abuse treatment were higher for persons with severe mental illness and a co-occurring substance use disorder in most states, compared with odds for those with a substance use disorder alone. Conclusions: Heavy inpatient and emergency department use by Medicaid beneficiaries with co-occurring substance use disorders is a consistent cross-state problem. Co-occurring disorders may decrease the likelihood of community-based treatment for those with less severe mental disorders and for those with severe mental illness, suggesting that policies focusing only on these settings may miss a significant proportion of people with these co-occurring disorders.