Objectives: To compare the racial/ethnic differences in treatment quality among youth with primary care provider-initiated versus mental health specialist-initiated care for major depressive disorders (MDD). Methods: A retrospective cohort study was conducted using the [2005][2006][2007] Medicaid claims data from Texas. Youth aged 10-20 during the study period were identified if they had two consecutive MDD diagnoses and received either medications for MDD or psychotherapy. Patients who received ≥84 days of medications and/or ≥4 sessions of psychotherapy for MDD treatment during 4 months of follow-up were considered meeting the minimum adequacy of treatment. Results: The generalized linear multilevel model (MLM) analysis revealed that both Hispanics and Blacks were approximately 30% less likely to receive adequate treatment (Hispanics -OR: 0.67; 95% CI: 0.6-0.8) (Blacks -OR: 0.66; 95% CI: 0.6-0.8) and Hispanic children were 50% more likely to undergo MHrelated hospitalization (OR: 1.53; 95% CI: 1.1-2.2) compared to their White counterparts. The odds of meeting the minimum MDD treatment adequacy were comparable between pediatric MDD cases first identified by primary care providers (PCP-I) and psychiatrists (PSY-I) (PCP-I vs. PSY-I: OR: 0.97; 95% CI: 0.8-1.2), and slightly lower in those first identified by social workers/psychologists (SWP-I) as compared to PSY-I (SWP-I vs. PSY-I: OR: 0.81; 95% CI: 0.7-0.9). In all models, the interaction between race/ethnicity and type of provider who initiated MDD care was not statistically significant. Conclusions: Minority youths received less adequate MDD treatment compared to Whites. Hispanic children had the highest risk of having mental health-related hospitalization. The specialty of provider who initiated MDD care had limited impact on treatment quality and was not associated with the racial/ethnic variations in treatment completion and mental health-related hospitalizations.
Key Practitioner Message• The study aims to quantify the contribution of being first diagnosed by mental health specialists versus PCPs to the racial differences in MDD treatment completion and mental health-related hospitalizations.• Findings suggest that significant racial/ethnic differences exist in achieving minimum adequacy of treatment. White youths had more than 30% odds of achieving the minimum adequacy of treatment compared to Hispanics and Black youths.• Hispanics had the highest risk of having mental health-related hospitalizations.• As compared to those receiving the initial MDD diagnosis from PCPs, being diagnosed by mental health specialists was neither associated with improved treatment completion, nor associated with the reduction of racial/ethnic gaps in MDD treatment.
S121 studied. MethodS: A retrospective analysis was conducted of claims data, acquired from third party funders that contract the ICON Network, for the year 2016. The data (n 1 = 9444) was governed by a requirement to adhere to treatment protocols. The control group (n 2 = 2008) was under no protocol restriction and seen by a different group of oncologists. The hospital admission rate and total stay duration were measured per patient where the treating doctor for the hospital event was an oncologist. Case mix was adjusted by diagnosis (using admission ICD10 code). The smaller cohort dataset (n2) was extrapolated proportionally by diagnosis (random sampling with replacement). The same methodology was applied to 2015 data to validate the methodology. ReSultS: The hospitalisation rate for patients under protocolised treatment, 16.07%, was significantly less (99% CI, p< 0.0022, Chi-squared test) than the control group, 17.64%. The average hospital stay duration, 1.62 days, for patients under protocolised treatment was also significantly less (99% CI, p< 0.0022, student's t test) than the control group, 1.95 days. The results were validated against data from 2015 (n 1 = 8559, n 2 = 1870): that showed significantly lower hospitalisation rate and hospital stay duration in comparison to the control group. ConCluSionS: Using hospitalisation metrics as a proxy outcome of patient well-being and cost shifting, the ICON solution demonstrates significant value without compromising care.
A593reservations have restricted market access thus increasing co-pays. This is driven by stakeholder concerns on non-compliance leading to drug resistance, promiscuity, and development off a false sense of security resulting in a drop in HIV screening rates and protective measures. The gravity of the issue is judged by the fact that, FDA has called for a REMS to take care of these issues. ConClusions: The utilization of a new medical service is impacted by societal perceptions, especially those conflicting with general values. In spite of regulatory approvals and national recommendations supported by clinical evidences, low adoption and high co-pays reflects that the market access is significantly driven by strong prevailing societal views.
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