Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children.

OBJECTIVE: The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care. METHODS: Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period. Polypharmacy was defined as two or more psychotropic drug class prescriptions concurrently for ≥60 days. Psychotherapy was defined as receipt of any psychotherapy or adaptive behavior treatment. Neighborhood context (health, environment, education, and wealth) was measured with the Child Opportunity Index. Multilevel generalized linear mixed models with random intercept for census tracts were used to assess the associations between individual and neighborhood characteristics and psychotropic polypharmacy and psychotherapy. RESULTS: Moderate (vs. low) child opportunity was associated with higher odds of polypharmacy (adjusted OR [AOR]=1.79, 95% CI=1.19-2.67). High (vs. low) child opportunity was associated with higher odds of psychotherapy (AOR=2.15, 95% CI=1.43-3.21). Black (vs. White) race (AOR=0.51, 95% CI=0.37-0.71) and Hispanic ethnicity (AOR=0.44, 95% CI=0.26-0.73) were associated with lower odds of polypharmacy. CONCLUSIONS: Among high-need children, neighborhood Child Opportunity Index, race, and ethnicity were significantly associated with treatment outcomes in analyses adjusted for clinical factors. The findings underscore concerns about structural disparities and systemic racism and raise questions about access.

Neighborhood-Level Social Determinants of Health and Adolescent Mental Health.

OBJECTIVE: Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents. METHODS: We used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles. RESULTS: The sample included 50,011 adolescents ages 10-19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10-14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level. CONCLUSIONS: There are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

Assessing the safety and efficacy of prescribing psychologists in New Mexico and Louisiana.

This study aimed to compare patient outcomes between prescribing psychologists, psychiatrists, and primary care physicians (PCPs). Private insurance claims (2005-2021; n = 307,478) were used to conduct an active comparator, new user longitudinal cohort study developed using target trial emulation. Inverse propensity for treatment weighting was used to adjust for baseline differences in a range of sociodemographic, clinical, and contextual patient factors. Differences in the 1-year rate of health care visits for adverse drug events (ADEs), psychiatric emergency department (ED) utilization, medication adherence, and psychotropic polypharmacy were identified between prescribing psychologists and the other provider types using doubly robust Cox proportional hazards models. Compared to patients of psychiatrists, patients of prescribing psychologists had a 24% lower rate of ADEs (95% CI [0.60, 0.96]), a 20% lower rate of psychotropic polypharmacy (95% CI [0.74, 0.86]), and similar rates of psychiatric ED utilization and medication nonadherence. Compared to patients of PCPs, patients of prescribing psychologists had 138% higher rates of psychiatric ED utilization (95% CI [1.67, 3.39]), 175% higher rates of psychotropic polypharmacy (95% CI [2.53, 2.99]), 28% lower rates of medication nonadherence (95% CI [0.66, 0.78]), and similar rates of ADEs. Using robust pharmacoepidemiological methods, we noted that among mental health specialists, prescribing psychologists appear to be as safe and efficacious as psychiatrists in a large sample of privately insured patients. Notable differences in safety and efficacy when compared to PCPs may be attributable to differences between specialty and primary care. Future research on prescribing psychologists should move toward studies of care quality. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care.

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.

Demographics and clinical characteristics of patients of prescribing psychologists, psychiatrists, and primary care physicians.

To describe the characteristics of patients receiving psychotropic medication from prescribing psychologists, psychiatrists, and primary care physicians. This descriptive study was conducted using private insurance claims of patients from New Mexico and Louisiana receiving psychotropic medications (anticonvulsants, antidepressants, antipsychotics, hypotensive agents, anxiolytics/sedatives/hypnotics, and stimulants) from 2004 to 2021 (N = 307,478). Patient characteristics were captured during the 6 months prior to their first psychotropic medication using administrative information, diagnosis and procedure codes, and medication data. Logistic regression models estimated the associations of patient characteristics with prescriber type. Additional logistic regression models estimated the association of prescriber type with medication classes prescribed. Patients were most likely to see specialists (psychologists or psychiatrists) if they had bipolar disorder (average marginal effect and 95% CI 0.214 [0.196, 0.231]), schizophrenia/psychotic disorders (0.118 [0.097, 0.138]), or had 1-4 visits of psychotherapy (0.267 [0.258, 0.026]). Specialist patients were most likely to see a prescribing psychologist if they had 1-4 visits of psychotherapy (0.196 [0.183, 0.210]) or had insomnia (0.309 [0.203, 0.415]). Prescribing psychologists were more likely to prescribe antidepressants (0.028 [0.011, 0.045]) and less likely to prescribe antipsychotics (-0.016 [-0.020, -0.012]) than psychiatrists. Primary care physicians were less likely to prescribe all psychotropic medications except antidepressants (0.011 [0.002, 0.019]) and anxiolytics (0.074 [0.067, 0.080]). Prescribing psychologists treat patients who are more similar to those of psychiatrists than patients of primary care physicians; they are less likely to prescribe antipsychotics and more likely to prescribe antidepressants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pediatric Mental Health Care and Scope-of-Practice Expansions.

To examine the association between psychologist and nurse practitioner scope-of-practice (SoP) regulations and pediatric mental health service access. A nationally representative sample of children with mental health needs was identified using 5 years of National Survey of Children's Health (2016-2020). Utilization was measured in two ways: (1) unmet mental health care needs and (2) receipt of mental health medication. Expanded SoP for psychologists and nurse practitioners was measured based on the child's state of residence and the year of the survey. The associations between both SoP expansion and both outcomes were assessed using logistic regression models adjusted for multiple covariates. The probability of having unmet mental health needs was 5.4 percentage points lower (95% CI - 0.102, - 0.006) for children living in a state with psychologist SoP expansion; however, there was no significant difference in unmet mental health needs between states with and without NP SoP expansion. The probability of receiving a mental health medication was 2.0 percentage points higher (95% CI 0.007, 0.034) for children living in a state with psychologist SoP expansion. Conversely, the probability of receiving a mental health medication was 1.5 percentage points lower (95% CI - 0.023, - 0.007) for children living in a state with NP SoP expansion. Expanded SoP for psychologists is associated with improved access to pediatric mental health care in terms of both unmet need and receiving medication. Expanded SoP for NPs, however, was not associated with unmet need and lower receipt of medication.

North Carolina Medicaid System Perspectives on Substance Use Disorder Treatment Policy Changes During the COVID-19 Pandemic.

OBJECTIVE: This study aimed to describe perspectives from stakeholders involved in the Medicaid system in North Carolina regarding substance use disorder (SUD) treatment policy changes during the coronavirus disease 2019 pandemic. METHODS: We conducted semistructured interviews in early 2022 with state agency representatives, Medicaid managed care organizations, and Medicaid providers (n = 22) as well as 3 focus groups of Medicaid beneficiaries with SUD (n = 14). Interviews and focus groups focused on 4 topics: policies, meeting needs during COVID, demand for SUD services, and staffing. RESULTS: Overall, policy changes, such as telehealth and take-home methadone, were considered beneficial, with participants displaying substantial support for both policies. Shifting demand for services, staffing shortages, and technology barriers presented significant challenges. Innovative benefits and services were used to adapt to these challenges, including the provision of digital devices and data plans to improve access to telehealth. CONCLUSIONS: Perspectives from Medicaid stakeholders, including state organizations to beneficiaries, support the continuation of SUD policy changes that occurred. Staffing shortages remain a substantial barrier. Based on the participants' positive responses to the SUD policy changes made during the coronavirus disease 2019 pandemic, such as take-home methadone and telehealth initiation of buprenorphine, these changes should be continued. Additional steps are needed to ensure payment parity for telehealth services.

Family Support Services and Reported Parent Coping Among Caregivers of Children with Emotional, Behavioral, or Developmental Disorders.

OBJECTIVE: Caregivers of children with special health care needs (CSHCN) experience substantial strain caring for their child's special needs because of high needs for health and other support services. Caregivers of CSHCN with emotional, behavioral, or developmental problems (EBDPs) report stress and poor mental health at higher rates than caregivers of other CSHCN. Although family support services are associated with caregiver mental health and well-being among families of CSHCN, the association of these factors with caregiver coping has been underexamined. METHOD: Using the Double ABCX Model of Family Adaptation to guide variable selection, this study uses 2016 to 2019 data from the National Survey of Children's Health. Univariate, bivariate, and multivariate logistic analyses examined the association between caregivers' receipt of adequate care coordination and emotional support services and their reported coping with the day-to-day strains of parenting. These relationships are compared between caregivers of CSHCN with and without EBDPs. RESULTS: Receipt of adequate care coordination was associated with higher rates of caregiver-reported positive coping for all caregivers of CSHCN who have no source of emotional support. Receipt of emotional support services was associated with increased reports of positive coping for caregivers for all CSHCN as well. Caregivers reporting only informal sources of emotional support, however, also reported higher rates of positive coping when compared with caregivers with no source of emotional support. CONCLUSION: Mobilization of resources that can aid caregivers in coordinating care and provide emotional support may play a key role in positive caregiver coping for families of CSHCN.

Patterns of Mental Health Service Use During the Transition to Adulthood Among Autistic Adolescents and Young Adults.

Background: The time of transition into adulthood, especially when leaving school, is a time when many autistic adolescents and young adults (AYA) may stop receiving mental health services that they have relied on, leading to worse mental health outcomes. The purpose of this study was to describe patterns of mental health service use during transition to adulthood among autistic AYAs. Methods: We performed a cross-sectional study using electronic health records from years 2015 to 2019 from one large university health care system. We included autistic individuals ages 11-27 with at least one clinical encounter annually in the cohort. Outcomes included psychotropic medications and psychotherapy received, psychotropic polypharmacy, psychiatric emergency department (ED) visits, and adverse drug events. Results: Almost half of the 529 patients in the cohort received polypharmacy. The most common treatment was medication only (56.9%), followed by no treatment (22.7%), medication plus psychotherapy (18.7%), and psychotherapy only (data masked). The 17-21 age group had the highest odds of a psychiatric ED visit, whereas the 22-27 age group had the highest odds of receiving psychotropic medications and polypharmacy. Black AYA were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. Conclusion: Autistic individuals may benefit from more support from the health care system for their transition into adulthood to maintain use of beneficial mental health services as they leave school and to reduce the frequency of adverse outcomes. Access to providers experienced treating the complex needs of autistic individuals is important to reduce disparities.

Why is this an important issue?: Autistic adolescents and young adults often do not receive the mental health care services they need. As they transition into adulthood, they may lose important mental health services they relied on during childhood. Losing services may negatively affect their health and produce bad outcomes such as emergency department visits. Previous studies have suggested that autistic individuals often stop receiving important services as they leave school and lose access to school-based services. What was the purpose of this study?: The purpose was to describe patterns of mental health service use during the transition to adulthood among autistic adolescents and young adults. Underutilized services might indicate areas where the health care system needs to improve. What did the researchers do?: We used data from electronic health records from a large university health system in the southeastern United States. We identified autistic adolescents and young adults ages 11­27 in the data. We analyzed whether they received medication and/or psychotherapy for their mental health, and whether they had emergency department visits and adverse drug events. We also examined polypharmacy, meaning the use of multiple medications of different classes for mental health. What were the results of the study?: Almost half of the 529 included patients experienced polypharmacy. The majority received medication only, whereas smaller percentages received medication plus psychotherapy or psychotherapy alone. Emergency department visits were most common in the 17­21 age group, and psychotropic medications and polypharmacy were most used in the 22­27 age group. Black individuals were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. What do these findings add to what was already known?: These findings show that providers are relying heavily on medication, often including polypharmacy, to treat mental health issues in autistic adolescents and young adults. What are potential weaknesses of the study?: The study used only one health care system in one state and may not reflect what happens in other states with different policies. Data may include a high number of patients with complex medical conditions, which may not reflect the typical patient's experience. Medications prescribed by providers outside this particular health system may not be captured. How will these findings help autistic adults now or in the future?: These findings reveal potential areas for improvement for providers and health systems in treating autistic adults. Ensuring that autistic adolescents can continue to receive important mental health services as they age into adulthood can improve their health.

Psychotropic Medication Prescribing Across Medical Providers, 2016-2019.

OBJECTIVE: The authors sought to provide updated estimates of the proportion of psychotropic medications prescribed by different medical providers. METHODS: This pooled cross-sectional study used data from the Medical Expenditure Panel Survey (2016-2019). Nationally representative estimates of the percentages of all psychotropic medications prescribed by each provider type were calculated, and analyses stratified by medication type, insurance type, and age were conducted. RESULTS: Data from 58,547 psychotropic prescriptions reported by 7,693 unique individuals were analyzed. More than 60% of psychotropic medications were prescribed by providers other than psychiatrists (33.5%) or psychologists (2.2%), such as general practitioners, nurse practitioners, and physician assistants. This distribution varied significantly by medication, insurance, and patient age. CONCLUSIONS: Most psychotropic medication prescribing occurs in primary care; however, notable differences by medication, insurance, and age were observed, suggesting areas for future research.

Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.

INTRODUCTION: North Carolina's 2017 STOP Act implemented several measures to address the increasing opioid overdose death rate. However, due to racial differences prescription opioid use and treatment service access, the STOP Act may exhibit differential impacts by race. This study examined the impact of the STOP Act on opioid overdose deaths by race. METHODS: State-level secondary data were compiled for all 50 states. Race-stratified opioid overdose rates were obtained from the Centers for Disease Control and Prevention's WONDER database from 2010 to 2019. The study obtained state-level population characteristics from the Current Population Surveys from 2010 to 2016, the CDC's 2017 Drug Surveillance Report, the National Survey of Substance Abuse Treatment Services from 2011 to 2016, and the National Survey on Drug Use and Health from 2010 to 2016. We obtained outcomes from 2010 to 2019 and state characteristics were obtained for the pre-STOP Act period (2010-2016) as available. Using the synthetic control method, we created two synthetic North Carolinas, one Black/African American and one White, from a weighted average of other states similar to North Carolina in terms of pre-STOP Act race-stratified opioid overdose rates and population characteristics. Change was assessed as the difference in the race-stratified opioid overdose death rate for North Carolina the corresponding synthetic control. RESULTS: The opioid overdose death rate among the White population decreased by 7.17 and 8.96 deaths/100 k in 2018 and 2019 following the STOP Act (overall decrease p = .0217); however, the study found no significant change in the opioid overdose death rate among the Black/African American population (overall decrease p = .1053), with decreases 1.68 and 3.2 deaths/100 k in 2018 and 2019, respectively. CONCLUSIONS: Our findings suggest that the STOP Act reduced the opioid overdose death rate in North Carolina among the White, but not Black/African American, population. This heterogeneous effect has implications for health equity and can inform the development of future substance use policies.

Examining Psychologist Prescriptive Authority as a Cost-Effective Strategy for Reducing Suicide Rates.

Six states (NM, LA, IL, IA, ID, CO) grant prescriptive authority to qualified psychologists, and research has shown that these policies are associated with a reduction in suicides. In this study, we assess the cost-effectiveness of these policies in reducing suicide rates. This study used a Markov Model with a time horizon of 20 years to estimate the incremental net monetary benefit (INMB) of the policy from the societal perspective with a simulated cohort of 100,000 people. Transition probabilities and utilities were collected from the literature, and costs were assessed using a mixed macro-micro costing approach. Using this approach, we found that the 20-year INMB for the policy was estimated to be $12.81 million ($USD) per quality-adjusted life year (QALY). The probability of cost-effectiveness was greater than 50% at a willingness-to-pay threshold as low as $10,000 per QALY. The probability of cost-effectiveness was only modestly associated with the implementation costs of the policy, but was sensitive to the estimated effect of the policy intervention. The models estimated in this study support prescriptive authority for psychologists as a cost-effective strategy for reducing state-level suicide rates. A considerable amount of research is needed to understand the impact of this policy with finer granularity.

"You can get a couple of ramen noodle packs for a BusparⓇ": A qualitative examination of medication access, policy, and procedures in southern jails.

BACKGROUND: Jails in the United States are required to provide health care to the over 10 million people entering jails each year, a significant portion of whom need medications. Yet little is known about the processes by which medications are prescribed, obtained, and administered to incarcerated persons in jails. OBJECTIVE: To describe medication access, policy, and procedures in jails. METHODS: Semi-structured interviews were conducted with administrators and health workers from 34 jails (of 125 contacted) across 5 states in the southeastern United States. The interview guide covered all aspects of healthcare in jails from entry to release; however, the present study focused on responses relating to medications. Interviews were thematically coded using a combination of deductive and inductive coding guided by the research objective. RESULTS: Four processes described medication use chronologically from intake to release: jail entry and health screening, pharmacy and medication protocols, protocols specific to medication dispensing and administration, and medications at release. Many jails had procedures for using medications brought from home, though some declined to use these medications. Medication decision-making in jails was primarily performed by contracted healthcare providers, and most medications were obtained from contract pharmacies. Almost all jails banned narcotics; however, other medication restrictions varied by jail. Most jails charged a copay for medications. Participants discussed various privacy practices related to medication distribution, as well as approaches to diversion prevention including "crushing and floating" medications. Finally, the pre-release medication management process included transition planning that ranged from no planning to sending additional prescriptions to the patient's pharmacy. CONCLUSIONS: Medication access, protocols, and procedures in jails varies considerably, and there is a need for further adoption of existing standards and guidelines for the use of medications in jails, such as the Assess, Plan, Identify, and Coordinate (APIC) model of community re-entry.

Emotional Support Among Parents of Children With Adverse Childhood Experiences.

INTRODUCTION: We assess the association between a child's exposure to adverse childhood experiences (ACEs) and the parent's current experiences of emotional support. METHOD: This study used pooled cross-sectional data from the National Survey of Children's Health (N = 129,988). Emotional support for the parent was classified by the presence (any emotional support, no emotional support) and type (any formal support or only informal support). All models were adjusted for relevant predisposing, enabling, and need factors. RESULTS: Having two or more ACEs was associated with a higher probability of any emotional support (average marginal effect = 0.017; 95% confidence interval = 0.002-0.032) and a higher probability of formal support (average marginal effect = 0.049; 95% confidence interval = 0.028-0.069). Several individual ACEs were associated with the presence and type of emotional support. DISCUSSION: Parents of children with higher ACEs are likelier to have emotional support, especially formal support.

Evaluating the impact of prescriptive authority for psychologists on the rate of deaths attributed to mental illness.

BACKGROUND: Five states have enacted policies granting prescriptive authority to psychologists in an effort to increase access to psychoactive medications; however, little is known regarding the public health impact of these policies. Policies in two of these states, New Mexico and Louisiana, have had sufficient time to license more than a handful of prescribing psychologists. This study estimates the impact of psychologist prescriptive authority policies in New Mexico and Louisiana on deaths attributable to mental illness and suicides. METHODS: State-level annual death rates from all 50 states were obtained for deaths with an underlying cause of death attributable to mental illness and to suicide (1999-2013) from the Centers for Disease Control and Prevention's WONDER database. State characteristics were collected for the pre-policy time period (1999-2004). We estimated the impact of the policy on the rates of deaths attributable to mental illness and to suicide using a comparative interrupted time series design, and policy effect estimates were generated for New Mexico and Louisiana separately. We used the synthetic control method to create synthetic New Mexico and synthetic Louisiana for use as the comparators. RESULTS: Immediately following the start of psychologist prescribing, the rate of deaths attributable to mental illness declined by 4.55 deaths per 100,000 (95% CI: [-8.30, -0.79]) in New Mexico relative to the control, but there was no change in Louisiana. There was no immediate change in the suicide rate in either state; however, the annual change in the overall suicide rate was 0.12 suicides per 100,000 (95% CI: [-0.18, -0.06]) per year lower than expected in Louisiana following implementation. CONCLUSIONS: These findings suggest that policies granting prescriptive authority to psychologists have the potential to reduce the mental health mortality gap, though considerable questions remain.

Opioid Use Disorder Practice by Licensure Category in North Carolina.

Background: Nurse practitioners, physician assistants, and certified nurse midwives, collectively known as advanced practice providers (APPs), are critical members of the opioid use disorder (OUD) treatment workforce. Few studies compare the OUD treatment practice patterns of APPs relative to physicians. Methods: In this cross-sectional study, we distributed a survey examining general substance use disorder (SUD) and OUD-specific treat-ment practices to all licensed physicians and APPs in North Carolina, resulting in a sample of 332 respondents. Respondents were asked about screening, referrals, and Drug Enforcement Administration (DEA) X-waiver status. Waivered providers were asked about prescribing buprenorphine. Differences in practice patterns by provider type were examined using descriptive statistics and chi-squared tests. Results: Practice patterns were similar between APPs and physicians; however, more APPs reported screening their patients for SUDs (83.3% versus 69.4%, p = .0045). Of the providers who were waivered to prescribe buprenorphine, APPs and physicians were equally likely to be currently prescribing buprenorphine (75.8% versus 77.1%, p = .8900). Limitations: This was a descriptive cross-sectional study using self-report data from a purposive sample and may not be representative of all providers. Conclusions: Our results describe practice patterns for APPs and physicians and differences that may be reflective of regulations and therapeutic approaches. Similarities in obtaining an X-waiver and prescribing buprenorphine suggest that reducing restrictions on APPs may result in a larger treatment workforce.

Neighborhood context and children's health care utilization and health outcomes: a comprehensive descriptive analysis of national survey data.

While child health and health care disparities arising from unequal distribution of resources are well documented, a nationally representative inventory of health and well-being for children across the spectrum of opportunity is lacking. Using the nationally representative sample of children from pooled 2013-2017 Medical Expenditure Panel Survey data linked to the census-tract-level Child Opportunity Index 2.0, a composite measure of neighborhood health, education, and socioeconomic conditions, we describe US children's socioeconomic characteristics, health care utilization and expenditures across the spectrum of child neighborhood opportunity levels. We found that neighborhood level of child opportunity was associated with almost all of children's health status, health care utilization, expenditures, access to care, and satisfaction with care outcomes. Children living in lower-opportunity neighborhoods had the highest rates of poor physical and mental health status and fewest ambulatory care visits but accounted for the highest share of emergency department visits. Their parents were also least likely to report having positive experiences with health care, good communication with providers, and easy access to care. Our findings underscore the myriad harms to children of gaps in health, education, and financial resources at the community level and provide targets for public investments to improve child-focused outcomes.

Factors associated with contraceptive use among postpartum women with substance use disorder.

OBJECTIVE: Rates of unintended pregnancy among women with substance use disorder (SUD) are much higher than the general reproductive-age population, suggesting lower rates of contraceptive use. This study aims to determine the prevalence of contraceptive use in postpartum women with SUD and identify factors associated with its use. METHODS: This retrospective cohort study using electronic health record data from 2016 to 2019 included postpartum adult women with any SUD who received care at a high-risk pregnancy clinic (n = 353). The primary outcome was contraception utilization as identified using diagnosis and procedure codes. An adjusted multivariate logistic regression was used to evaluate the relationship between postpartum contraceptive use and sample characteristics. RESULTS: Of the 353 postpartum women with SUD, contraceptive use was found in 128 (36.3%) women. Among the study population, the most commonly reported substance use disorders were nicotine use disorder (70.3%), opioid use disorder (51.3%), and cannabis use disorder (15.0%). Among those with opioid use disorder, 45.3% were found to be using medication for opioid use disorder (MOUD). Women who attended a postpartum visit had 2.23 times the odds of using contraception compared to women who did not (OR: 2.23, 95% CI: 1.20-4.15). Those using MOUD had 3.69 times the odds of using contraception compared to those who were not (OR: 3.69, 95% CI: 1.89-7.19). Overall, women who utilized contraception were more likely to be younger than 25, receiving MOUD, and participating in postpartum care. CONCLUSIONS: Postpartum women with SUD are not using contraceptive methods and this is associated with a lack of appropriate healthcare interventions in the perinatal period, which can reduce the odds of receiving effective family planning services. Specialized whole-health interventions and policies to increase access to care for women with SUD should be developed.

Eligible Prescriber Experiences with Substance Use Disorder Treatment and Perceptions of Pharmacy Barriers to Buprenorphine.

OBJECTIVES: The primary aim of this study was to better understand North Carolina providers' specific substance use disorder (SUD) and opioid use disorder treatment practices and buprenorphine prescribing. Furthermore, this study aimed to provide novel information regarding US South and rural providers' opioid use disorder treatment behaviors and perceptions of patient experience at community pharmacies. METHODS: An online survey consisting of closed-ended and open-ended questions was used. Surveys were delivered to healthcare providers' e-mails and self-administered. Surveys were administered through an online survey platform. RESULTS: In total, 332 healthcare providers, who were eligible to be X-waivered to prescribe buprenorphine, completed the online survey. Survey participants reported not having their X-waiver to prescribe buprenorphine or actively prescribing buprenorphine. The majority of participants were uncertain of potential barriers to filling buprenorphine prescriptions. Providers treating a mix of rural and urban patients reported being less likely to screen for SUDs. Although there were no rurality differences in SUD screening, providers who treat mostly rural patients reported a lack of SUD treatment options in their area. CONCLUSIONS: Early detection of SUDs can help prevent negative health outcomes for patients. Regardless of patient rurality, providers should screen for SUDs and familiarize themselves with the patient's experience when filling a buprenorphine prescription, along with possible barriers. Furthermore, providers should incorporate questions about their patient's ability to receive buprenorphine to help ensure that patients are receiving proper and necessary treatment.