Search

Introduction:Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods:This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results:A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies (n = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes (n = 41; 44.1%), patient satisfaction (n = 9; 9.7%), and attendance/compliance (n = 5; 5.4%). Provider-level outcomes included knowledge change (n = 11; 11.8%) and self-efficacy (n = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion:This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost–benefit. [ABSTRACT FROM AUTHOR]

Introduction: Estimating Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure rates in Medicaid can help target program efforts to improve access to services. Methods: The data for this study was extracted from the 2016–2020 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) and included infants born between January 1, 2016 and December 31, 2020 with a either a NAS diagnosis or prenatal substance exposure. Results: Between 2016 and 2020, the estimated national rate of NAS experienced a 18% decline, while the estimated national rate of prenatal substance exposure experienced a 3.6% increase. At the state level in 2020, the NAS rate ranged from 3.2 per 1000 births (Hawaii) to 68.0 per 1000 births (West Virginia). Between 2016 and 2020, 28 states experienced a decline in NAS births and 20 states had an increase in NAS rates. In 2020, the lowest prenatal substance exposure rate was observed in New Jersey (9.9 per 1000 births) and the highest in West Virginia (88.1 per 1000 births). Between 2016 and 2020, 38 states experienced an increase in the rate of prenatal substance exposure and 10 states experienced a decline. Discussion: Estimated rate of NAS has declined nationally, but rate of prenatal substance exposure has increased, with considerable state-level variation. The reported increase in prenatal substance exposure in the majority of US states (38) suggest that substances other than opioids are influencing this trend. Medicaid-led initiatives can be used to identify women with substance use and connect them to services. Significance: What is already known about the topic? Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure are significant risk factors for poor neurodevelopmental and mental health outcomes in early childhood. NAS birth rates have been increasing in the US since 2000 and the majority of NAS births are covered by Medicaid. What this article adds? This article estimates national and state-level prenatal substance exposure and NAS rates among Medicaid-covered infants born between 2016-2020 using data from the Transformed Medicaid Statistical Information System. This is the first study using post-2017 data to estimate national NAS rates. The findings can inform future federal and state policy efforts to improve access to screening, diagnosis and treatment among pregnant women with substance use disorder and infants with NAS. [ABSTRACT FROM AUTHOR]

Introduction: Limited information exists on the landscape of studies and policies for remote patient monitoring (RPM) in the United States. Methods: We conducted a scoping review to assess (1) for which adult patient populations and health care needs is RPM being used and (2) the landscape of national- and state-level reimbursement policies for RPM. This study was guided by the Arksey and O'Malley methodological framework for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. Results: A total of 399 articles were included in our final sample: 268 study articles and 131 articles of gray literature (e.g., websites, legislative bills). RPM-related articles rose drastically from 2015 to 2021, and the vast majority of articles were peer-reviewed journal articles. Of the study articles, prospective cohort studies were the most common study method, with m-health/smart watches being the most common RPM modality. RPM was found to be most commonly tested within patients with cardiovascular diseases, and the most common outcomes measured were usability and feasibility. Gray literature found 36 U.S. state Medicaid programs had reimbursement policies for RPM in 2021; however, 28 of those had at least one restriction on reimbursement (e.g., limited to specific providers). Conclusions: Despite the rapid growth in the literature on RPM and the adoption of reimbursement policies, retrospective, population-level studies, large randomized controlled trials, studies with a focus on additional favorable outcomes (e.g., quality of life), and studies evaluating trends in RPM reimbursement policies are lacking in the current literature. [ABSTRACT FROM AUTHOR]

Purpose: Buprenorphine utilization remains low in the United States. Telemedicine guidelines and flexibilities introduced during the COVID‐19 pandemic provide an opportunity to increase patient access to buprenorphine. However, it is not known whether Americans without access to buprenorphine waivered provider, especially those residing in rural counties, have sufficient broadband internet access to support telemedicine. Methods: Administrative data from the Substance Abuse and Mental Health Services Administration's Buprenorphine Treatment Practitioner Locator Tool and the Fixed Broadband Deployment Data from the Federal Communications Commission are utilized to identify counties with low broadband penetration rate and the number of buprenorphine waivered providers with capacity to accept patients within a 30 miles radius. Findings: 23.9% of the US population does not have access to any buprenorphine waivered provider with a capacity to accept new patients within a 30 miles radius. In counties with low broadband penetration rate, 78.9% of residents does not have access to any buprenorphine waivered provider with patient capacity. In rural counties with low broadband penetration rate, 82.3% of the residents does not have access to any buprenorphine waivered provider with patient capacity within a 30 miles radius. Conclusions: Federal policy initiatives are expected to continue the COVID‐19‐related telehealth flexibilities and to increase the number of providers available to prescribe buprenorphine, but for that to translate into more patients utilizing treatment via telemedicine, high‐speed internet access will be essential. This is particularly salient for residents in rural counties where access to both buprenorphine providers and high‐speed internet access is limited. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted to review surveillance features and program development by six states of the U.S. including Arizona, Florida, Georgia, Kentucky, Tennessee, and Virginia after the enactment of state laws, to better understand neonatal abstinence syndrome (NAS) surveillance beyond initial case reporting. It is noted that mandated reporting helped quantify NAS incidence and inform programs and services.

Objective: Higher rates of substance use in rural counties compared to urban counties have been well documented. Low perceived need for treatment among those with substance use disorder (SUD) has also been documented in the literature. However, not much is known about SUD treatment among parenting women in rural counties and the impact of perceived need for treatment in seeking care. Little research has also examined barriers to SUD treatment among parenting women in rural communities. Methods: Using a large nationally representative dataset, the study utilizes multivariable logistic regression models to estimate the differences in utilizing SUD treatment among parenting women with SUD in rural and urban counties in the United States. Role of perceived need for SUD treatment and barriers related to finance, access, and stigma are also examined. Results: Parenting women in rural counties with SUD who perceive a need for treatment have more than 90% lower odds of receiving treatment compared to those in urban counties. In addition, parenting women with SUD in rural counties have more than 50% higher odds of identifying access‐related issues such as lack of openings in programs, unavailability of treatment facilities, and lack of transportation as barriers to care compared to parenting women in urban counties. Conclusion: Diagnosis of SUD among parenting women is steadily increasing in rural communities. While many resources in combatting maternal SUD are being utilized, policy and programmatic responses tailored for mothers with SUD in rural communities might help increase utilization of treatment and reduce barriers to treatment. [ABSTRACT FROM AUTHOR]

A correction notice is presented related to the article "Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016–2020 Transformed Medicaid Statistical Information System " which was published on July 17, 2023 issue of the periodical.

In the context of the opioid epidemic, a limited but growing body of literature has found state medical marijuana laws (MMLs) to be associated with lower levels of opioid prescribing. However, robust evidence linking state MMLs with individual-level opioid-related outcomes is lacking, particularly among women. This finding is especially true for pregnant and parenting women, who have been disproportionately affected by the opioid crisis. Using data drawn from the 2002–2014 National Survey on Drug Use and Heath, the study uses a difference-in-differences estimation strategy to compare opioid-related outcomes (opioid misuse initiation, opioid misuse in the past month and past year, and opioid use disorder) among all women, pregnant women, and parenting women in states with and without MMLs (before and after implementation). The study also investigates the impact of MMLs on marijuana use and marijuana use disorder. The findings indicate that MMLs were not associated with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women, and parenting women. These laws were, however, positively correlated with marijuana use and marijuana use disorder among all women and women with children. In addition, MMLs were associated with an increase in the frequency of opioid misuse for pregnant women and a decrease in the frequency of opioid misuse for parenting women. This finding suggests that, although medical marijuana may be viewed by some as a substitute for opioid analgesics, MMLs may not be an effective policy tool to tackle the opioid epidemic among women, especially pregnant and parenting women. [ABSTRACT FROM AUTHOR]

Background: Opioid overdose is a national health priority and curbing inappropriate prescribing is critical. In 2016, the Centers for Disease Control and Prevention (CDC) issued appropriate prescribing guidelines. Objectives: Examine associations between care networks defined by shared patients and problematic opioid prescribing. Methods: Analysis was at the provider-year level. Social network analysis (SNA) applied to the Medicaid MarketScan® Research Database for the years 2010–2015 identified care communities, each community's level of integration (centralization), and each provider's integration (centrality). Nested multivariable logistic regressions controlling for patient mix and provider specialty simultaneously examined the risk of any (incident) and repeated (prevalent) inappropriate prescribing. Outcomes: Four behaviors defined by the CDC guidelines were examined: (1) more than 90 days continuous supply of high-dose opioid analgesics for chronic pain, (2) overlapping opioid supplies, (3) overlapping opioid and benzodiazepine prescriptions, and (4) prescribing an extended release opioid for an acute pain diagnosis. Results: Provider centrality was associated with reduced incidence of outcome (2) (OR: 0.95) and decreased prevalence of outcomes (1), (2), and (3). However, higher incidence (OR: 1.32) and prevalence (OR: 1.027) of outcome (4) were observed. Conversely, centralization associated with decreased incidence of (1) and (2) and lower prevalence of (1), (2), and (3). Conclusions: Greater provider integration is associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription is more ambiguous. [ABSTRACT FROM AUTHOR]

Background: The health and financial burden of the opioid epidemic has been disproportionately hard on reproductive-aged parenting women. This crisis not only impacts the well-being of the mothers but is also spilling over to their children and families. Objectives: Given the alarming rise of opioid use disorder (OUD) among mothers, this study seeks to examine the primary motivations and sources for the most recent prescription opioids misused among this population. Methods: Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study analyzes data on reproductive-aged parenting women who have misused any prescription opioids in the previous 12 months. All estimates were weighted to account for NSDUH's complex survey design and to make the estimates nationally representative (weighted N ≈ 14.4 million). Results: Results show that physicians (43%) are the most commonly reported source for obtaining prescription opioids among parenting women with OUD, whereas social sources (57%) are the most common source for parenting women who have misused opioids without OUD. A significant proportion of parenting women with OUD reported drug-related reasons (57%) and relief from physical pain (25%) as the two primary motivations for opioid misuse, while parenting women without OUD reported relief from physical pain (45%) and help with emotions or feelings (32%) as primary motivations. Conclusions: Opioid misuse and use disorder among parenting women are a significant health risk. Policy initiatives that encompasses a comprehensive approach toward the crisis are warranted. [ABSTRACT FROM AUTHOR]

BACKGROUND: Schools play an important role as providers of mental health services for adolescents; however, information on the broader picture of utilization of mental health services in educational versus other settings is limited because of the lack of national‐level data. METHODS: Using multinomial logistic regression models based on national‐level data from the 2012–2015 National Survey on Drug Use and Health, we explore the characteristics of adolescents who received mental health treatment in educational and other settings. In addition, the study examines the reasons for seeking services in various treatment settings. RESULTS: The analysis finds that while the majority of adolescents who access mental health services receive care at noneducational settings, slightly more than one‐third of them received services only in an educational setting. Adolescents who had public insurance, were from low‐income households, and were from racial/ethnic minority groups were more likely to access services in an educational setting only. Common reasons for accessing services in educational settings included problems with schools, friends, and family members. CONCLUSIONS: Despite increased access to treatment in outpatient settings in the last decade, schools play an important role in providing access to mental health services for disadvantaged populations. [ABSTRACT FROM AUTHOR]

Objective: Children and adolescents with diagnosed mental disorders may require developmentally tailored interventions. However, little is known about the difference in mental health treatment utilization among children by age group and health insurance coverage.Methods: Using the 2016 MarketScan database, the study examined treatment utilization patterns by health insurance coverage (private and Medicaid) and developmental age group (preschool-age children, ages 3-5; young children, ages 6-11; and adolescents, ages 12-17).Results: Psychiatric medication only was the most common form of treatment utilization among all children, regardless of developmental age group or insurance coverage. Specifically, psychiatric medication only was received by 38% of preschool-aged children with Medicaid and 42% of those with private insurance, 43% of young children with Medicaid and 39% of those with private insurance, and 55% of adolescents with Medicaid and 49% of those with private insurance.Conclusions: Given that evidence-based practices suggest that combined treatment with psychiatric medications and psychotherapy may be the recommended treatment, the study's findings raise potential concerns about the high use of medication-only treatment. [ABSTRACT FROM AUTHOR]

Objective: Examine how behavioral health (BH) integration affects health care costs, emergency department (ED) visits, and inpatient admissions.Data Sources/study Setting: Truven Health MarketScan Research Databases.Study Design: Social network analysis identified "care communities" (providers sharing a high number of patients) and measured BH integration in terms of how connected, or central, BH providers were to other providers in their community. Multivariable generalized linear models adjusting for age, sex, number of prescriptions, and Charlson comorbidity score were used to estimate the relationship between the centrality of BH providers and health care utilization of BH patients.Data Collection/extraction Methods: Used outpatient, inpatient, and pharmacy claims data from six Medicaid plans from 2011 to 2013 to identify study outcomes, comorbidities, providers, and health care encounters.Principal Findings: Behavioral health centrality ranged from 0 (no BH providers) to 0.49. Relative to communities at the median BH centrality (0.06), in 2012, BH patients in communities at the 75th percentile of BH centrality (0.31) had 0.2 fewer admissions, 2.1 fewer all-cause ED visits, and accrued $1,947 fewer costs, on average.Conclusions: Increased behavioral centrality was significantly associated with a reduced number of ED visits, less frequent inpatient admissions, and lower overall health care costs. [ABSTRACT FROM AUTHOR]

Introduction: Since the 1990's, governmental and non-governmental organizations have adopted several measures to increase access to the opioid overdose reversal medication naloxone. These include the implementation of laws that increase layperson naloxone access and overdose-specific Good Samaritan laws that protect those reporting overdoses from criminal sanction. The association of these legal changes with overdose mortality and non-medical opioid use is unknown. We assess the relationship of (1) naloxone access laws and (2) overdose Good Samaritan laws with opioid-overdose mortality and non-medical opioid use in the United States.Methods: We used 2000-2014 National Vital Statistics System data, 2002-2014 National Survey on Drug Use and Health data, and primary datasets of the location and timing of naloxone access laws and overdose Good Samaritan laws.Results: By 2014, 30 states had a naloxone access and/or Good Samaritan law. States with naloxone access laws or Good Samaritan laws had a 14% (p = 0.033) and 15% (p = 0.050) lower incidence of opioid-overdose mortality, respectively. Both law types exhibit differential association with opioid-overdose mortality by race and age. No significant relationships were observed between any of the examined laws and non-medical opioid use.Conclusions: Laws designed to increase layperson engagement in opioid-overdose reversal were associated with reduced opioid-overdose mortality. We found no evidence that these measures were associated with increased non-medical opioid use. [ABSTRACT FROM AUTHOR]

Research has shown a significant increase in overdose deaths among reproductive-aged parenting women in the United States. Given the alarming rise of opioid use disorder, this study analyzes polysubstance use among reproductive-aged parenting women. Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study examines data on prevalence and patterns of polysubstance use among US reproductive-aged parenting women who misused prescription opioids in the past 30 days. Results show that 87% of parenting women who misused prescription opioids reported using other substances concurrently in the past 30 days. [ABSTRACT FROM AUTHOR]

Objective: Given low psychiatrist participation in insurance networks, this study examines how psychiatrists are reimbursed in network and out of network under commercial insurance relative to other providers for the same diagnoses and services.Methods: Paid private insurance claims from the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounters Database were analyzed. The sample included all services billed for 3.8 million individuals with a mental disorder as the primary diagnosis by psychiatrists, nonpsychiatrist medical doctors, psychologists, social workers, or psychiatric nurses. The authors determined the most common services provided by each provider type, the median reimbursement and median out-of-pocket payment for the services by provider type and by network status (in or out of network), and the proportion of bills for services delivered out of network.Results: "Evaluation and management" services for presenting problems of low to moderate and moderate to high severity were the two procedures most frequently billed by psychiatrists and nonpsychiatrist medical doctors. The median reimbursement for services for presenting problems of low to moderate and moderate to high severity was 13% less ($66 versus $76) and 20% less ($91 versus $114), respectively, for psychiatrists versus nonpsychiatrist medical doctors if the services were provided in network but 28% higher ($100 versus $78) and 6% higher ($122 versus $115), respectively, for psychiatrists versus nonpsychiatrist medical doctors for services provided out of network.Conclusions: Psychiatrists receive lower in-network reimbursement than nonpsychiatrist medical doctors for many of the same services. This may contribute to psychiatrists' lower participation in insurance networks relative to other providers and has implications for patient cost sharing and access to psychiatrists. [ABSTRACT FROM AUTHOR]

• The number of patients with dispensed psychotropic medications declined during the early months of the pandemic but experienced a significant growth in later periods. • The number of psychotropic medications dispensed declined during the early months of the pandemic but experienced a significant growth in later periods. • Average days supply of psychotropic medications dispensed increased significantly throughout the pandemic. • Commercial insurance remained the primary payer for psychotropic medication throughout the pandemic. • There was a significant increase in the number of prescription fills covered under Medicaid. The early months of the COVID-19 pandemic saw a decline in psychotropic medication use; however, little is known about how this trend evolved as the pandemic progressed and how it varied across different payers in the United States. Using a national multi-payer pharmacy claims database and adopting a quasi-experimental research design, this study examines trends in psychotropic medication prescriptions dispensed from July 2018 - June 2022. The study finds that the number of patients with dispensed psychotropic medications and the number of psychotropic medications dispensed declined during the early months of the pandemic but experienced a statistically significant growth in later periods compared to the pre-pandemic rate. Average days supply of psychotropic medications dispensed increased significantly throughout the pandemic. Commercial insurance remained the primary payer for psychotropic medication during the pandemic, but there was a significant increase in the number of prescription fills covered under Medicaid. This implies that public insurance programs played an increasing role in financing psychotropic medication use during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: Since full implementation of the Affordable Care Act (ACA) in 2014, the number of uninsured individuals in the United States has declined considerably; however, millions still lack health insurance. Although 29% of the remaining uninsured population (8.5 million individuals) have a mental or substance use disorder, little is known about this population.Methods: This study used data from the 2014 National Survey on Drug Use and Health to describe demographic characteristics, socioeconomic status, and use of behavioral health services among adults (ages 18-64) with a behavioral disorder who remained uninsured (unweighted N=2,300; weighted N of approximately 8.5 million).Results: Over half of individuals with a behavioral disorder who remained uninsured were non-Hispanic whites. The largest age group was 26- to 35-year-olds. Most worked in clerical or blue-collar occupations, and less than 20% were college graduates and above. More than 90% could qualify for insurance assistance under the ACA, either through Medicaid eligibility (income <138% of the federal poverty level [FPL]) or eligibility for cost-sharing subsidies or tax credits on the health insurance exchanges (income ≥138% but <400% of the FPL). Rates of behavioral health treatment were low; however, nearly half of Medicaid-eligible individuals (46%) reported a past-year emergency department visit.Conclusions: The high proportion of behavioral health conditions among the remaining uninsured population, and the fact that a significant portion of this population would be eligible for ACA insurance support, highlights the need for continued educational outreach efforts and steps to remove barriers to treatment access. [ABSTRACT FROM AUTHOR]

Purpose There is concern that veterans living in rural areas may not be receiving the mental health (MH) treatment they need. This study uses recent national survey data to examine the utilization of MH treatment among military veterans with a MH condition living in rural areas, providing comparisons with estimates of veterans living in urban areas. Methods Multivariable logistic regression is utilized to examine differences in MH service use by urban/rural residence, controlling for other factors. Rates of utilization of inpatient and outpatient treatment, psychotropic medication, any MH treatment, and perceived unmet need for MH care are examined. Findings There were significant differences in MH treatment utilization among veterans by rural/urban residence. Multivariate estimates indicate that compared to veterans with a MH condition living in urban areas, veterans in rural areas had 70% lower odds of receiving any MH treatment. Veterans with a MH condition in rural areas have approximately 52% and 64% lower odds of receiving outpatient treatment and prescription medications, respectively, compared to those living in urban areas. Differences in perceived unmet need for mental health treatment were not statistically significant. Conclusions While research indicates that recent efforts to improve MH service delivery have resulted in improved access to services, this study found that veterans' rates of MH treatment are lower in rural areas, compared to urban areas. Continued efforts to support the provision of behavioral health services to rural veterans are needed. Telemedicine, using rural providers to their maximum potential, and engagement with community stakeholder groups are promising approaches. [ABSTRACT FROM AUTHOR]

A large number of adults with substance use disorder (SUD) do not receive treatment for their condition. Using data from the 2008-2013 National Survey of Drug Use and Health (NSDUH), this study analyzes why individuals with SUD report not receiving treatment even when they perceived a need for it. It further examines the variations in reported reasons for not receiving treatment by health insurance status and type. The results suggest that barriers such as stigma, lack of readiness to stop using substances, and not making treatment a priority are more common among the insured population, especially among those with private insurance. Financial barriers, such as not being able to afford the cost of treatment, are more prominent among the uninsured population. Efforts to improve utilization of treatment services will need to address financial as well as barriers related to stigma. [ABSTRACT FROM AUTHOR]

Objective: Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity.Methods: The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668).Results: Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups.Conclusions: The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group. [ABSTRACT FROM AUTHOR]

This study examines the relationship between parental comorbid mental illness and substance use disorder (SUD) and adolescent SUD. Nationally representative parent-child data pooled over six years from the National Survey on Drug Use and Health (NSDUH) was utilized in this study. Multivariable regression analysis was conducted to determine whether adolescents living with parents who have mental health disorders and/or substance use disorder are themselves more likely to have SUD while controlling for potential confounding variables. The results show that comorbid AMI-SUD in mothers is significantly associated with adolescent SUD after controlling for potential confounders. However, comorbid AMI-SUD in fathers is not associated with adolescent SUD when other controls are included in the model. The association of parental comorbid AMI-SUD with adolescent SUD indicates that parental behavioral health treatment may be a preventive measure to protect their children and may function as an important deterrent to adolescent SUD. [ABSTRACT FROM AUTHOR]

Considering the ubiquity of concrete's structural, architectural, and environmental applications in buildings, a research study was carried out to determine how the thermal mass property of concrete could improve the energy performance of buildings. The results have shown that extreme climate zones can better exploit the thermal mass property of the material. This article initially reviews the fundamental concepts of thermal mass. It then specifically explores the impact of thermal mass concrete on building energy performance in six U.S. climate zones through Energy Plus simulation and analysis. The building occupancy types (office and residential), window-to-wall area ratio, and height are chosen as the parameters to evaluate the impact of thermal mass on building energy performance. In addition, the annual heating and cooling energy demands are selected as the measurement indices of building energy consumption. This article presents the results of the study, interprets them, and draws conclusions about the potential benefits of thermal mass for both residential and office occupancies, which are deemed to be important to researchers and design professionals. These results indicate that other influential design variables such as slab thickness and thermal mass distribution could also be taken into account to demonstrate broader implications and benefits of thermal mass in different climate zones. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify patterns of postdischarge prescription fills following an opioid-related hospitalization.Methods: Using the 2010-2014 MarketScan Commercial Claims and Encounters database, this analysis identified the percentage of patients (N=36,719) with an opioid-related inpatient admission who received substance use disorder treatment medications within 30 days of being discharged.Results: Thirty-five percent of the sample did not have any prescription fills in the 30-day postdischarge period. Less than a quarter (16.7%) of patients received any FDA-approved opioid dependence medication in the 30 days following discharge. Forty percent of patients in the sample received antidepressants, 15.6% received antipsychotics, 13.9% filled a prescription for a benzodiazepine, and 22.4% filled a prescription for an opioid pain medication.Conclusions: More effort is needed to ensure that patients hospitalized for opioid misuse are receiving recommended services. [ABSTRACT FROM AUTHOR]

Background: Past research shows that individuals with opioid use disorder (OUD) have a higher rate of co-occurring mental health conditions, but little research has examined suicidal behavior (suicidal ideation and/or attempts) and utilization of behavioral health services among individuals with OUD using a nationally representative sample.Methods: Using the 2015-2018 National Survey of Drug Use and Health, this study examines the risk of suicidal behavior among individuals with OUD. In addition, the study examines how utilization of behavioral health treatment among individuals with OUD might mitigate the risk of suicidal behavior.Results: The rate of suicidal behavior was higher among individuals with OUD (22%) than among those without OUD (4%). Among those with OUD, 43% reported receiving neither substance use disorder nor mental health treatment. Multivariable logistic regression estimates indicate that individuals with OUD had odds of suicidal behavior 2.9 times as high as those without OUD. Odds of suicidal behavior among people with OUD were 49% lower with substance use disorder treatment, 5% lower with mental health treatment, and 28% lower with both.Conclusion: Individuals with OUD have a high risk of suicidal behavior, which can be mitigated with utilization of behavioral health treatment. These findings underscore the importance of policy initiatives directed at increasing treatment utilization among those with OUD. [ABSTRACT FROM AUTHOR]

Background: Past studies show that illicit opioid use may impair parents' ability to care for their children. However, few studies have examined adverse outcomes in adolescent children of mothers who misuse opioids.Methods: Data come from the National Survey on Drug Use and Health's nationally representative matched sample of mothers and their adolescent children who resided in the same household. The outcome of interest was whether adolescents engaged in aggressive or antisocial behaviors in the past year. Using logistic regression, adolescent children whose mothers engaged in past-year opioid misuse were respectively compared to children whose mothers used other illicit drugs, had an alcohol use disorder, or had no misuse of substances. To control for confounding, propensity scores were used to match the three other maternal substance use groups to mothers who misused opioids on a number of measured confounding variables.Results: The odds of antisocial behaviors were 1.6 times higher among adolescent children whose mother engaged in past-year opioid misuse than matched adolescent children whose mothers reported no illicit substance use. There was no significant difference in antisocial behaviors between adolescents whose mothers misused opioids and either adolescents whose mothers used illicit drugs or had an alcohol use disorder.Conclusion: As the United States seeks to respond to the needs of families impacted by its ongoing opioid crisis, it is likely that services will be needed not only for parents who misuse opioids, but also for their children, who are at elevated risk for adverse behavioral outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on increases in providers with buprenorphine waivers in the U.S. from 2016 to 2019. Topics include the Drug Addiction Treatment Act of 2000 (DATA) has created a program that provides waivers, allowing qualified physicians to prescribe buprenorphine for opioid use disorder in an office-based setting, and the number of DATA has waivered providers more than doubled since regulatory changes were implemented in 2016.

The impact of the opioid epidemic has been particularly hard on reproductive-aged parenting women. Yet, very little is known about opioid use, opioid misuse and opioid use disorder among parenting women with major depressive episode (MDE). Information on sources of opioids intended for misuse and reasons for opioid misuse among this population is also lacking. Using the 2015-2016 National Survey on Drug Use and Health, the study estimates a multinomial logistic regression model to investigate the association between MDE and opioid misuse as well as use disorder among reproductive-aged parenting women (n = 7750). Among reproductive-aged parenting women with prescription opioid use in the past 12 months, having had a MDE was associated with a higher relative risk of misusing prescription pain relievers without use disorder (RRR = 1.38, p < .001) and having a use disorder (RRR = 1.99, p < .001), relative to using prescription opioid without misuse or use disorder. However, utilization of mental health treatment mitigated the risk for opioid misuse and use disorder. A significant proportion of parenting women regardless of their MDE status identified family or friends and physicians as their main source of opioids. Relief from physical pain and help with feelings or emotions were the two primary motivations for opioid misuse among this population. These findings underscore the importance of maternal depression and mental health treatment in undertaking policy initiatives directed at the opioid crisis and highlights the role of medical providers, family and friends in targeted interventions aimed at this population. [ABSTRACT FROM AUTHOR]

The increasing prevalence of opioid use disorders among pregnant and postpartum women (PPW) has generated a need for greater availability of specialized programs offering evidence-based and comprehensive substance use disorder treatment services tailored to this population. In this study, we used data from the 2007 to 2018 National Survey of Substance Abuse Treatment Services to describe recent time trends and the geographic distribution of treatment facilities with specialized programs for PPW. We also compared differences in the availability of opioid agonist medication treatments (MT), key ancillary services, and health insurance acceptance between PPW Programs and Other Programs, overall and by residential and outpatient settings. We found that the prevalence of PPW Programs increased from 17% in 2007 to 23% in 2018, for a total of 3,429 PPW Programs and 11,230 Other Programs in 2018. The prevalence of PPW Programs was lowest in some states in the South and Midwest. Compared to Other Programs, PPW Programs were more likely to accept Medicaid (75% vs. 64%) and offer opioid agonist MTs methadone (24% vs. 6%), buprenorphine (44% vs. 30%), or both (18% vs. 4%). PPW Programs were also more likely to offer other key ancillary services such as childcare (16% vs. 3%), transportation (50% vs. 42%), and domestic violence assistance (51% vs. 35%). Compared to PPW Programs in outpatient settings, PPW Programs in residential settings were more likely to offer these key ancillary services but less likely to offer methadone or accept Medicaid. Our findings reflect considerable variation in the availability of PPW Programs over time and across states, as well as substantial gaps in key services offered in PPW Programs, let alone in Other Programs. [ABSTRACT FROM AUTHOR]

The article discusses the details of the work done by the U.S. Department of Veteran Affairs in the area of veteran peer support for mental health patients.

This study aimed to determine whether punitive state alcohol policies targeting pregnant women who drink alcohol are associated with decreased alcohol consumption among pregnant women over time. This study used data from the Pregnancy Risk Assessment Monitoring System (15 states) between 1990 and 2015. A difference-in-difference (DiD) approach was employed to determine whether passage of state laws changed alcohol consumption rates among pregnant women, while controlling for state and time fixed effects. The study specifically examined punitive state alcohol policies that clarify the admissibility of evidence in child welfare proceedings related to prenatal alcohol exposure, focusing on allegations of child abuse, child neglect, child deprivation, or child dependence, as well as proceedings seeking termination of parental rights. Punitive state alcohol policies were not significantly associated with decreased rates of alcohol consumption among pregnant women (+ 1.54%, 95% CI, -1.47-4.55), within 3 years of implementation. State alcohol policies that adopted a punitive stance toward pregnant women who drink alcohol did not result in the reduction of drinking during pregnancy. Given that punitive policies may not effectively reduce alcohol consumption during pregnancy, our findings highlight the need for reevaluation and potential reform to better address maternal/child health outcomes., (© 2024. The Author(s).)

Having health insurance is associated with better access to healthcare and lower rates of comorbidity in the general population, but data are limited on insurance's impact on adults with congenital heart disease (ACHD). The Congenital Heart Survey To Recognize Outcomes, Needs and well-beinG (CH STRONG) was conducted among ACHD in three locations from 2016 to 2019. We performed multivariable logistic regression to determine the associations between health insurance and both access to healthcare and presence of comorbidities. We also compared health insurance and comorbidities among ACHD to similarly-aged individuals in the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for the general population. Of 1354 CH STRONG respondents, the majority were ≤ 30 years old (83.5%), and 8.8% were uninsured versus 17.7% in the BRFSS (p < 0.01). Compared to insured ACHD, uninsured were less likely to report regular medical care (adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.1-0.3) and visited an emergency room more often (aOR 1.6, CI 1.0-2.3). Among all ACHD reporting disability, uninsured individuals less frequently received benefits (aOR 0.1, CI 0.0-0.3). Depression was common among uninsured ACHD (22.5%), but insured ACHD had lower rates of depression than insured in the BRFSS (13.3% vs. 22.5%, p < 0.01). In conclusion, rates of insurance were higher among ACHD compared to the general population. Nonetheless, uninsured ACHD inconsistently accessed healthcare and benefits. Further studies are needed to determine if insurance ameliorates the risk of morbidity as ACHD age., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To examine use of mental health treatment, substance use disorder treatment, and perceived barriers to treatment by whether a major depressive episode occurred during the past year among parenting women with opioid use disorder., Design: Secondary analysis of survey data from the National Survey on Drug Use and Health, 2015-2019., Setting: United States., Participants: Women aged 18 to 44 years with opioid use disorder and at least one child in the household., Methods: We computed descriptive statistics for demographic characteristics, treatment by major depressive episode status, and barriers to treatment by major depressive episode status. We conducted multinomial logistic regression to examine associations among demographic characteristics, major depressive episode status, and type of treatment., Results: Of the 36% of respondents in our weighted sample (N ≈ 254,300) who experienced major depressive episode, 35% received substance use disorder and mental health treatment, and 27% did not receive any form of treatment. We found that identification as a person of color was significantly associated with a lower relative risk of receiving any type of treatment. Frequently reported barriers to treatment included affordability, access, and stigma., Conclusion: Respondents with opioid use disorder and co-occurring major depressive episode did not obtain necessary treatment. Barriers to treatment, including affordability, access to treatment, and stigma, need to be addressed, particularly among women of color., Competing Interests: Conflict Of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Background: Hypertension management is complex in older adults. Recent advances in remote patient monitoring (RPM) have warranted evaluation of RPM use and patient outcomes., Objective: To study associations of RPM use with mortality and healthcare utilization measures of hospitalizations, emergency department (ED) utilization, and outpatient visits., Design: A retrospective cohort study., Patients: Medicare beneficiaries aged ≥65 years with an outpatient hypertension diagnosis between July 2018 and September 2020. The first date of RPM use with a corresponding hypertension diagnosis was recorded (index date). RPM non-users were documented from those with an outpatient hypertension diagnosis; a random visit was selected as the index date. Six months prior continuous enrollment was required., Main Measures: Outcomes studied within 180 days of index date included (i) all-cause mortality, (ii) any hospitalization, (iii) cardiovascular-related hospitalization, (iv) non-cardiovascular-related hospitalization, (v) any ED, (vi) cardiovascular-related ED, (vii) non-cardiovascular-related ED, (viii) any outpatient, (ix) cardiovascular-related outpatient, and (x) non-cardiovascular-related outpatient. Patient demographics and clinical variables were collected from baseline and index date. Propensity score matching (1:4) and Cox regression were performed. Hazard ratios (HR) and 95% confidence intervals (CI) are reported., Key Results: The matched sample had 16,339 and 63,333 users and non-users, respectively. Cumulative incidences of mortality outcome were 2.9% (RPM) and 4.3% (non-RPM), with a HR (95% CI) of 0.66 (0.60-0.74). RPM users had lower hazards of any [0.78 (0.75-0.82)], cardiovascular-related [0.79 (0.73-0.87)], and non-cardiovascular-related [0.79 (0.75-0.83)] hospitalizations. No significant association was observed between RPM use and the three ED measures. RPM users had higher hazards of any [1.10 (1.08-1.11)] and cardiovascular-related outpatient visits [2.17 (2.13-2.19)], while a slightly lower hazard of non-cardiovascular-related outpatient visits [0.94 (0.93-0.96)]., Conclusions: RPM use was associated with substantial reductions in hazards of mortality and hospitalization outcomes with an increase in cardiovascular-related outpatient visits., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: Infants with prenatal substance exposure or neonatal abstinence syndrome (NAS) use health services more often than other children; however, little is known about their use of mental health services and psychotropic medication., Methods: The sample (N=1,004,085) consisted of infants born in 2016 in 38 states who were followed through the fifth year of life and enrolled each year in Medicaid or the Children's Health Insurance Program. Infants with prenatal substance exposure or NAS were identified with ICD-10 diagnosis codes; procedure and revenue codes documented their service use., Results: Rates of any mental health visit and of psychotropic medication use were higher among infants with prenatal substance exposure or NAS compared with infants without either condition; these patterns persisted during most years of the 5-year study., Conclusions: Infants' elevated mental health services use through their first 5 years of life highlights the importance of early screening and subsequent engagement in school-based mental health interventions., Competing Interests: The authors report no financial relationships with commercial interests.

Previous research suggests that enrolling in Medicaid reduces evictions by improving health and providing financial protection. However, previous studies have not examined whether the loss of Medicaid affects eviction outcomes. We analyzed eviction filings and completed evictions after a large, mandatory Medicaid disenrollment in Tennessee in 2005. We conducted a difference-in-differences analysis using data from the Eviction Lab at Princeton University and found that relative to other southern states, the TennCare disenrollment led to a 27.6 percent greater increase in the average annual number of eviction filings at the county level during the period 2005-09 and a 24.5 percent greater increase in the average annual number of completed evictions at the county level during that same period. Our findings have implications for the housing stability of Medicaid recipients today, many of whom are being disenrolled because of the unwinding of the Medicaid continuous enrollment provision that is occurring across the country. To protect housing stability for people disenrolled from Medicaid, policy makers may wish to consider new initiatives aimed at preventing an increase in eviction.

Introduction: Telehealth use in obstetrics has been demonstrated to improve efficiency, access to care, and pregnancy outcomes. Despite reported successful implementation of these programs, information regarding the program variations and its impact on health care costs and outcomes are scarce. Methods: This is a scoping review of pregnancy-related telehealth studies to understand the current landscape of pregnancy-related telehealth interventions as well as to subset those that are used in high-risk pregnancies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework to guide this review. Results: A total of 70 articles were included in this scoping review. Of those, 53 (75.7%) studies included a pregnant population and 17 (24.3%) studies focused on a rural and/or urban population. Most studies ( n  = 56; 80%) included some form of synchronous interaction between provider and participant. Patient outcomes included maternal/infant health outcomes ( n  = 41; 44.1%), patient satisfaction ( n  = 9; 9.7%), and attendance/compliance ( n  = 5; 5.4%). Provider-level outcomes included knowledge change ( n  = 11; 11.8%) and self-efficacy ( n  = 3; 3.2%). Other outcomes included assessment of costs and patient/provider feasibility and acceptability of the intervention. Overall, there has been a growing trend in articles published on pregnancy-related telehealth studies since 2011, with 2018 having the most publications in a single year. Conclusion: This review suggests a steadily growing body of literature on pregnancy-related telehealth interventions; however, more research is needed to better understand outcomes of telehealth for pregnancy-related care, especially related to patient satisfaction, health disparities, and cost-benefit.

Background: The rates of SMM have been steadily increasing in Arkansas, a southern rural state, which has the 5th highest maternal death rate among the US states. The aims of the study were to test the functionality of the Bateman index in association to SMM, in clustering the risks of pregnancies to SMM, and to study the predictability of SMM using the Bateman index., Study Design: From the ANGELS database, 72,183 pregnancies covered by Medicaid in Arkansas between 2013 and 2016 were included in this study. The expanded CDC ICD-9/ICD-10 criteria were used to identify SMM. The Bateman comorbidity index was applied in quantifying the comorbidity burden for a pregnancy. Multivariable logistic regressions, KMeans method, and five widely used predictive models were applied respectively for each of the study aims., Results: SMM prevalence remained persistently high among Arkansas women covered by Medicaid (195 per 10,000 deliveries) during the study period. Using the Bateman comorbidity index score, the study population was divided into four groups, with a monotonically increasing odds of SMM from a lower score group to a higher score group. The association between the index score and the occurrence of SMM is confirmed with statistical significance: relative to Bateman score falling in 0-1, adjusted Odds Ratios and 95% CIs are: 2.1 (1.78, 2.46) for score in 2-5; 5.08 (3.81, 6.79) for score in 6-9; and 8.53 (4.57, 15.92) for score ≥10. Noticeably, more than one-third of SMM cases were detected from the studied pregnancies that did not have any of the comorbid conditions identified. In the prediction analyses, we observed minimal predictability of SMM using the comorbidity index: the calculated c -statistics ranged between 62% and 67%; the Precision-Recall AUC values are <7% for internal validation and <9% for external validation procedures., Conclusions: The comorbidity index can be used in quantifying the risk of SMM and can help cluster the study population into risk tiers of SMM, especially in rural states where there are disproportionately higher rates of SMM; however, the predictive value of the comorbidity index for SMM is inappreciable.

Introduction: The COVID-19 pandemic brought about renewed interest and investment in telehealth, while also highlighting persistent health disparities in the Southern states. Little is known about the characteristics of those utilizing telehealth services in Arkansas, a rural Southern state. We sought to compare the characteristics of telehealth utilizers and nonutilizers among Medicare beneficiaries in Arkansas before the COVID-19 public health emergency to provide a baseline for future research investigating disparities in telehealth utilization. Methods: We used Arkansas Medicare beneficiary data (2018-2019) to model telehealth use. We included interactions to assess how the association between the number of chronic conditions and telehealth was moderated by race/ethnicity and rurality, adjusted for covariates. Results: Overall telehealth utilization in 2019 was low ( n  = 4,463; 1.1%). The adjusted odds of utilizing telehealth was higher for non-Hispanic Black/African Americans (vs. white, adjusted odds ratio [aOR] = 1.34, 95% confidence interval [CI] = 1.17-1.52), rural beneficiaries (aOR = 1.99, 95% CI = 1.79-2.21), and those with more chronic conditions (aOR = 1.23, 95% CI = 1.21-1.25). Race/ethnicity and rurality were significant moderators, such that the association between the number of chronic conditions and telehealth was strongest among white and among rural beneficiaries. Discussion: Among the 2019 Arkansas Medicare beneficiaries, having more chronic conditions was most strongly associated with telehealth use among white and rural individuals, while the effect was not as pronounced for Black/African American and urban individuals. Our findings suggest that advances in telehealth are not benefiting all Americans equally, with aging minoritized communities continuing to engage with more strained and underresourced health systems. Future research should investigate how upstream factors such as structural racism perpetuate poor health outcomes.

Objective: This study examined telepsychiatry use among children enrolled in Medicaid before and during the COVID-19 pandemic., Methods: A retrospective analysis was conducted of claims data from the Transformed Medicaid Statistical Information System for children (ages 3-17) with any mental health service use in 2019 (N=5,606,555) and 2020 (N=5,094,446)., Results: The number of children using mental health services declined by 9.1% from 2019 to 2020. Mental health services in all care settings (inpatient, outpatient, residential, emergency department, intensive outpatient/partial hospitalization) declined except for telehealth, which increased by 829.6%. In 2020, 44.5% of children using telehealth were non-Hispanic White, 16.1% were non-Hispanic Black, and 19.7% were Hispanic. Attention-deficit hyperactivity disorder, trauma, anxiety, depression, and behavior/conduct disorder were the most prevalent psychiatric diagnoses among children using telehealth services., Conclusions: Although telehealth use increased substantially in 2020, overall mental health service use declined among Medicaid-enrolled children. Telehealth may not fully address unmet mental health service needs., Competing Interests: The authors report no financial relationships with commercial interests.

Introduction: Limited information exists on the landscape of studies and policies for remote patient monitoring (RPM) in the United States. Methods: We conducted a scoping review to assess (1) for which adult patient populations and health care needs is RPM being used and (2) the landscape of national- and state-level reimbursement policies for RPM. This study was guided by the Arksey and O'Malley methodological framework for scoping reviews and the Joanna Briggs Institute Manual for Evidence Synthesis. Results: A total of 399 articles were included in our final sample: 268 study articles and 131 articles of gray literature (e.g., websites, legislative bills). RPM-related articles rose drastically from 2015 to 2021, and the vast majority of articles were peer-reviewed journal articles. Of the study articles, prospective cohort studies were the most common study method, with m-health/smart watches being the most common RPM modality. RPM was found to be most commonly tested within patients with cardiovascular diseases, and the most common outcomes measured were usability and feasibility. Gray literature found 36 U.S. state Medicaid programs had reimbursement policies for RPM in 2021; however, 28 of those had at least one restriction on reimbursement (e.g., limited to specific providers). Conclusions: Despite the rapid growth in the literature on RPM and the adoption of reimbursement policies, retrospective, population-level studies, large randomized controlled trials, studies with a focus on additional favorable outcomes (e.g., quality of life), and studies evaluating trends in RPM reimbursement policies are lacking in the current literature.

Several studies have concluded that legalizing medical marijuana can reduce deaths from opioid overdoses. Drawing on micro data from the National Survey on Drug Use and Health, a survey uniquely suited to assessing patterns of substance use, we examine the relationship between recreational marijuana laws (RMLs) and the misuse of prescription opioids. Using a standard difference-in-differences (DD) regression model, we find that RML adoption reduces the likelihood of frequently misusing prescription opioids such as OxyContin, Percocet, and Vicodin. However, using a two-stage procedure designed to account for staggered treatment and dynamic effects, the DD estimate of relationship between RML adoption and the likelihood of frequently misusing prescription opioids becomes positive. Although event study estimates suggest that RML adoption leads to a decrease in the frequency of prescription opioid abuse, this effect appears to dissipate after only 2 or 3 years., (© 2022 John Wiley & Sons Ltd. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)