RESUMO
OBJECTIVES: We investigate, among older adult nursing home residents diagnosed with depression, whether depression treatment differs by race and schooling, and whether differences by schooling differ by race. We examine whether Blacks and less educated residents are placed in facilities providing less treatment, and whether differences reflect disparities in care. METHOD: Data from the 2006 Nursing Home Minimum Data Set for 8 states (n = 124,431), are merged with facility information from the Online Survey Certification and Reporting system. Logistic regressions examine whether resident and/or facility characteristics explain treatment differences; treatment includes antidepressants and/or psychotherapy. RESULTS: Blacks receive less treatment (adj. OR = .79); differences by education are small. Facilities with more Medicaid enrollees, fewer high school graduates, or more Blacks provide less treatment. DISCUSSION: We found disparities at the resident and facility level. Facilities serving a low-SES (socioeconomic status), minority clientele tend to provide less depression care, but Blacks also receive less depression treatment than Whites within nursing homes (NHs).
Assuntos
População Negra/psicologia , Depressão/etnologia , Disparidades em Assistência à Saúde/etnologia , Casas de Saúde , População Branca/psicologia , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , População Negra/estatística & dados numéricos , Depressão/terapia , Escolaridade , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Medicaid , Psicoterapia/estatística & dados numéricos , Estados Unidos , População Branca/estatística & dados numéricosRESUMO
OBJECTIVES: People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap. METHODS: We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally. RESULTS: Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia. CONCLUSIONS: Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
Assuntos
Infecções por HIV/epidemiologia , Medicaid/estatística & dados numéricos , Esquizofrenia/epidemiologia , Crime/estatística & dados numéricos , Infecções por HIV/complicações , Humanos , Prevalência , Esquizofrenia/complicações , Fatores Socioeconômicos , Sociologia Médica/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING: Community, usual care. PARTICIPANTS: Older Medicare fee-for-service beneficiaries. MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/tratamento farmacológico , Vida Independente , Meio Social , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/efeitos adversos , Antidepressivos/classificação , Terapia Combinada , Estudos Transversais , Transtorno Depressivo/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/epidemiologia , Uso de Medicamentos/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medicare/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Resultado do Tratamento , Estados UnidosRESUMO
In order to examine relationships between depression treatments (antidepressant and/or psychotherapy utilization) and adherence to antiretroviral therapy (ART), we conducted a retrospective analysis of medical and pharmacy insurance claims for privately insured persons living with HIV/AIDS (PLWHA) diagnosed with depression (n = 1,150). Participants were enrolled in 80 insurance plans from all 50 states. Adherence was suboptimal. Depression treatment initiators were significantly more likely to be adherent to ART than the untreated. We did not observe an association between psychotherapy utilization and ART adherence, yet given the limitations of the data (e.g., there is no information on types of psychological treatment and its targets), the lack of association should not be interpreted as lack of efficacy.
Assuntos
Antirretrovirais/uso terapêutico , Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Infecções por HIV/psicologia , Seguro Saúde , Cooperação do Paciente , Setor Privado , Adolescente , Adulto , Distribuição por Idade , Depressão/psicologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Revisão da Utilização de Seguros , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: The study examined relationships between adherence to bipolar medication and to antiretroviral therapy, measured by medication fills, among patients with diagnoses of bipolar disorder and HIV infection. METHODS: A retrospective study was conducted of Medicaid claims data (2001-2004) from eight states, focusing on antiretroviral adherence. The unit of analysis was person-month (N=53,971). The average observation period for the 1,687 patients was 32 months. Analyses controlled for several patient characteristics. RESULTS: Patients possessed antiretroviral drugs in 72% of the person-months. When a bipolar medication prescription was filled in the prior month, the rate of antiretroviral possession in the subsequent month was 78%, compared with 65% when bipolar medication was not filled in the prior month (p<.001). Odds of antiretroviral possession were 66% higher in months when patients had a prior-month supply of bipolar medication. CONCLUSIONS: Bipolar medication adherence may improve antiretroviral adherence among patients with bipolar disorder and HIV infection.
Assuntos
Antirretrovirais/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente , Adolescente , Adulto , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Medicaid , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to test the hypothesis that children with both social and biomedical risk factors are more likely to be in poorer health and utilize more health services than those with either type of risk alone. METHODS: Variables were identified using the 1998 National Health Interview Survey and tested here on 2002 data. Dependent variables were health (poorer health rating) and service use (hospitalization or greater than 2 emergency services). High social risk was defined as greater than 2 risk factors (parental education less than high school, family income <200% of federal poverty level, and non-2-parent family). High biomedical risk was defined as having a chronic condition or birth weight <2500 grams. RESULTS: Children with either high social or biomedical risk were significantly more likely to be in poorer health (odds ratio [OR] 3.1-3.4) and to have higher utilization (OR 1.7-2.1) than children at low risk on both dimensions. Children with high risk on both dimensions were significantly more likely to be in poorer health (OR 7.8-7.9) and have higher utilization (OR 3.5-3.7) on both social and biomedical risks and those children rated high risk on either dimension alone. Overall, social risk was as powerful as biomedical risk in these models and added substantially to biomedical risk. Findings were stable using different cut points for social risk and health ratings, and different definitions of chronic condition. CONCLUSIONS: These findings have implications for health care planners and insurers in estimating the burdens on clinicians and potential costs of delivering care to those with high social risks.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Nível de Saúde , Criança , Inquéritos Epidemiológicos , Humanos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados UnidosRESUMO
A sizable proportion of women remain married well into late life and an increasing proportion of them participate in the labor force. Since women tend to marry men older than themselves and men tend to experience serious illnesses at younger ages than women, women frequently witness declining health in their husbands. This is likely to affect a wife's labor-leisure trade-off in offsetting ways. Prior studies have not sought to disentangle the effect of a husband's poor health on his wife's reservation wage from the income effect of his ill health. We argue that, if we control for husband's earnings, the coefficient of husband's health in models of his wife's labor force participation (and hours of work) will reflect, in part, her preference over whether to decrease her labor supply to provide health care for her husband or whether to instead increase it to purchase this care in the market. However, husband's earnings are likely to be endogenous in these models due to unobserved characteristics common to husbands and wives. We find that the estimated effect of husband's health depends on whether we instrument for husband's earnings and on the health measure used. This is indicative of the importance of using a variety of health measures and controlling for husband's earnings, and their endogeneity, in future research on the effect of husband's health on wife's labor supply.