Mental Health and Substance Use Care Among Young Adults Before and After Affordable Care Act (ACA) Implementation: A Rural and Urban Comparison

Chavez, Laura J.; Kelleher, Kelly J.; Matson, Stacy; Wickizer, Thomas M.; Chisolm, Deena J.

doi:10.1111/jrh.12258

Cited by 20 publications

(14 citation statements)

References 18 publications

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Section: Discussionmentioning

confidence: 70%

“…Though this study was small and qualitative, perceptions and experiences reported by providers are supported by larger studies that have documented geographic differences in access to and utilization of specialty care, including care for substance use disorders. 28,33,35,[51][52][53] Research has shown that patients who receive primary care services in rural clinics have fewer specialty care encounters in general and significantly lower odds of specialty, mental health, and ancillary visits compared to patients seen in primary care clinics in urban areas. 28,33,53 Studies have also described multiple barriers to accessing substance use treatment in rural settings, including limited availability of treatment services, insufficient funding, transportation barriers, stigma-related barriers, and a lack of interagency collaboration.…”

Section: Discussionmentioning

confidence: 99%

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Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Young

Achtmeyer

Bensley

et al. 2018

The Journal of Rural Health

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Young

Achtmeyer

Bensley

et al. 2018

The Journal of Rural Health

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“…Changes in the US financing and delivery system due to the Affordable Care Act (ACA) insurance expansion and delivery system changes and innovations have differentially impacted rural areas. Understanding differences in referral patterns between rural and urban areas over time is important.…”

Section: Introductionmentioning

confidence: 99%

Differences in referral patterns for rural primary care physicians from 2005 to 2016

Geissler

2019

Health Services Research

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| INTRODUC TI ONReferrals from primary care physicians (PCP) to specialists and among different specialists and subspecialists are important contributors to medical care costs and quality. 1,2 Referrals have increased over time, potentially due to the increased complexity of medical care 1 ;research shows PCP referral rates are stable within physician over time, but have significant variation across physicians. 4-6 Referrals contribute to appropriate medical care 1,4 ; better understanding current determinants of referrals and appropriate use is important for improving care delivery, particularly in medically underserved rural areas. 7,8 Access to care and availability of specialists are concerns in rural areas due to distance to providers and the nonrural location of many specialists. 7-10 This results in decreased specialist visits and an increased reliance on PCPs in rural areas. 11The ideal PCP referral rate within and across conditions to optimize patient care to provide the highest quality at the lowest cost is unknown. Referrals may be both over-and under-used by PCPs 12 ; referrals may generate excess spending and increase care fragmentation, but specialists have been shown to be more likely to Abstract Objective: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. Study Design: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. Data Collection: Multiple years of data were combined.Principal Findings: A PCP visit was 1.9 percentage points (95% confidence interval: 0.1 pp, 3.8 pp) more likely to result in a referral in nonrural areas than rural areas, controlling for physician and patient characteristics, a 17 percent increase. This difference is driven by a widening gap in referral rates between nonrural and rural areas over time, with large differences in later periods. The regression-adjusted predicted probability of a PCP visit resulting in a referral was 71 percent higher in nonrural than rural areas in 2013-2014 and 92 percent higher in 2015-2016. Conclusions:Recognizing that the optimal PCP referral rate is unknown, referrals are less common in rural areas with a widening gap in recent years. This difference may reflect specialist availability, distance to care, or patient preferences. As changes occur to health care financing and delivery, continuing to monitor practice patterns is important to ensure patients are receiving appropriate levels of care across geographic regions. K E Y W O R D S ambulatory care, physician practice patterns, referrals, rural S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Geissler KH. Differences in referral patterns for rural primary care physicians from 2005 to 2016.Health Serv Res. 2020;55:94-102. https ://doi.

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“…In addition, the ACA called for a redesign of PC with a focus on the integration of physical and mental health services under patient-centered medical homes and accountable care organization reforms [ 46 , 47 , 48 ]. The few published investigations into mental health services use around the time of the ACA have not specifically examined PC-provided mental health services [ 9 , 49 , 50 , 51 ]. Moreover, limited research in this area has not accounted for heterogeneity within the Latino population with respect to both US versus foreign/island nativity and country of origin which, based on analyses of Black populations in the National Survey of American Life, can differ by nativity [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015

et al. 2018

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Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.

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Mental Health and Substance Use Care Among Young Adults Before and After Affordable Care Act (ACA) Implementation: A Rural and Urban Comparison

Abstract: Although rates of insurance increased for all young adults, a significant rural/urban difference persisted in 2014. Meaningful increases in MH and AOD treatment may require targeted efforts to reduce noninsurance barriers to treatment.

Cited by 20 publications

References 18 publications

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Differences in referral patterns for rural primary care physicians from 2005 to 2016

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015

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