Predicting substance use disorder treatment follow-ups and relapse across the continuum of care at a single behavioral health center.

INTRODUCTION: Substance use disorder is often a chronic condition, and its treatment requires patient access to a continuum of care, including inpatient, residential, partial hospitalization, intensive outpatient, and outpatient programs. Ideally, patients complete treatment at the most suitable level for their immediate individual needs, then transition to the next appropriate level. In practice, however, attrition rates are high, as many patients discharge before successfully completing a treatment program or struggle to transition to follow-up care after program discharge. Previous studies analyzed up to two programs at a time in single-center datasets, meaning no studies have assessed patient attrition and follow-up behavior across all five levels of substance use treatment programs in parallel. METHODS: To address this major gap, this retrospective study collected patient demographics, enrollment, discharge, and outcomes data across five substance use treatment levels at a large Midwestern psychiatric hospital from 2017 to 2019. Data analyses used descriptive statistics and regression analyses. RESULTS: Analyses found several differences in treatment engagement based on patient-level variables. Inpatients were more likely to identify as Black or female compared to lower-acuity programs. Patients were less likely to step down in care if they were younger, Black, had Medicare coverage were discharging from inpatient treatment, or had specific behavioral health diagnoses. Patients were more likely to relapse if they were male or did not engage in follow-up SUD treatment. CONCLUSIONS: Future studies should assess mechanisms by which these variables influence treatment access, develop programmatic interventions that encourage appropriate transitions between programs, and determine best practices for increasing access to treatment.

Assessing the impact of Geo-demographic factors on antibiotic prescribing for adults with acute, uncomplicated bronchitis.

Context: Acute bronchitis is a common reason patients seek primary care and has predominately viral causes. Yet, antibiotics are often prescribed despite limited evidence of clinical benefit. Interventions targeting antibiotic prescribing for acute bronchitis have reduced prescribing, but rates continued to remain higher than expected. There is also a paucity of data describing variability in antibiotic prescribing and its determinants; specifically, non-clinical, patient-level factors. Identifying non-clinical determinants of antibiotic prescribing for bronchitis could inform better care for these patients in primary care. Objective: To assess the impact of geo-demographic factors on antibiotic prescribing for ambulatory adults with acute, uncomplicated bronchitis. Study design: Cohort study. Setting: Ambulatory clinics, urgent cares and emergency departments within a large, single U.S. health-system. Population studied: Adult patients with a primary diagnosis of bronchitis in 2019. Outcome measures: Predictors of antibiotic prescribing. Results: There were 63,051 unique patients (mean age 48±18 years); 62.7% were female and 78.7% were non-Hispanic Caucasians. Of providers, 66.7% were physicians. Patients who were older (aOR 1.02, 95% CI 1.02-1.02), male (1.06, 1.03-1.10), black (1.21, 1.14-1.29), smoked (1.16, 1.12-1.20), had a nurse practitioner v. physician provider (1.11, 1.06-1.16) or a physician assistant v. physician provider (1.06, 1.01-1.11) were more likely to receive antibiotics. Patients who were Hispanic (0.87, 0.82-0.94), or Asian (0.85, 0.75-0.96) were less likely to receive antibiotics. Additionally, patients who had Medicare (0.78, 0.74-0.82), Medicaid (0.73, 0.69-0.77) or Exchange insurance (0.90, 0.82-0.98) or lived in a U.S. Census Block group with larger number of households without vehicles (0.66, 0.52-0.85) were less likely to receive antibiotics. Those living in an area with more owner-occupied housing were more likely to receive antibiotics (1.39, 1.25-1.53). The distance between a patient's residence and the encounter location did not impact the likelihood of antibiotic prescribing. Conclusions: This study identified antibiotic prescribing disparities for adults with acute bronchitis at the level of the patient, prescriber and the patient residential area. Interventions targeting antibiotic prescribing in this population should consider the role these factors have in prescribing decisions.

The Impact of Incarceration on Health and Health Care Utilization: a System Perspective.

BACKGROUND: Previously incarcerated individuals report high rates of chronic disease and reduced health care access. We characterized the impact of recent incarceration in jail or prison on chronic disease burden and health care utilization. METHODS AND FINDINGS: Incarceration data over 10 years were matched to health system data and patients were classified by recent incarceration status. Each cohort was stratified by gender and neighborhood socioeconomic status for utilization analysis. Main outcomes were chronic disease incidence and health care utilization. Incarceration had a significant but small effect on chronic disease incidence. Incarceration had a moderate to large effect on emergency department and behavioral health utilization, with additional differences seen by gender and socioeconomic status. CONCLUSION: Incarceration's impact on quantity and type of health care utilization varies with socioeconomic status and gender. Future work should evaluate the impact of length or number of cycles of incarceration on health or health care utilization.