Rapid Growth of Mental Health Services at Community Health Centers

Bruckner, Tim A.; Singh, Parvati; Snowden, Lonnie R.; Yoon, Jangho; Chakravarthy, Bharath

doi:10.1007/s10488-019-00947-w

Cited by 18 publications

(16 citation statements)

References 28 publications

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“…Over our test period, societal factors such as reduced stigma against psychiatric help‐seeking, or reduction in the patient out‐of‐pocket costs for mental health care, could account for the upward trend in psychiatric care both at CHCs and in EDs. Furthermore, these factors may differ across state‐ or county‐level settings . We encourage future research that investigates this general upward trend as well as geographic variation in this trend.…”

Section: Discussionmentioning

confidence: 94%

Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

Singh

Chakravarthy

Yoon

et al. 2019

Academic Emergency Medicine

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Objectives: Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)-which provide regional, low-cost primary care-correspond with fewer repeat psychiatric-related ED visits (PREDVs).Methods: We obtained repeated cross-sectional time-series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate-level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual-level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects.Results: The risk of a repeat PREDV decreased with a county-level increase in mental health patients seen at CHCs (incidence rate ratio = 0.986, 95% confidence interval = 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/ psychoses).

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Section: Discussionmentioning

confidence: 94%

Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

Singh

Chakravarthy

Yoon

et al. 2019

Academic Emergency Medicine

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“…Researchers further note that the current investment in FQHCs, whose most recent annual outlay exceeds $5.0 billion, may fall below sufficient levels given the prevalence of mental health needs in these underserved communities. Whereas a thorough cost‐effectiveness analysis remains outside of the scope of this paper, we encourage more rigorous evaluations of the efficiency of FQHC expansions . We also note that the penetration rate of FQHCs in many communities remains low.…”

Section: Discussionmentioning

confidence: 96%

“…One cross‐sectional study using 2001 data on adults finds a positive association between regional health system factors (eg, access to Federally Qualified Health Centers [FQHCs]) and African Americans’ help‐seeking in particular . FQHCs target low‐income, historically disadvantaged communities, and their reach has expanded by an unprecedented 70 percent in the last decade . Over 24.3 million Americans receive health care from FQHCs .…”

Section: Introductionmentioning

confidence: 99%

African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers

Bruckner

Singh

Yoon

et al. 2019

Health Services Research

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Objective: To test whether rapid expansion of mental health services in Federally Qualified Health Centers (FQHCs) reduces African American/white disparities in youth psychiatric emergency department (ED) visits. Data Sources: Secondary ED data for psychiatric care for 3.3 million African American and white youth in nine states, 2006-2011. We used the HCUP SEDD and SID. We obtained FQHC service data from the Uniform Data System. Study Design: The psychiatric ED visit is the dependent variable. Logistic regression methods control for individual risk factors for ED use, as well as county-level health system factors and county and year fixed effects. Key independent variables include indicators of mental health service capacity in FQHCs in a county-year. Data Extraction Methods: We extracted ED psychiatric visits for 3.3 million African American and white youth in nine states, 2006-2011, from the HCUP SEDD and SID, and FQHC data from the Uniform Data System. Principal Findings: Overall mental health visits at FQHCs correlate positively with psychiatric ED visits among African American youth. However, increases in the number of mental health visits per FQHC patient corresponds with fewer outpatient psychiatric ED visits among African American youth, relative to white youth (odds ratio = 0.96; 95% CI = 0.94, 0.98). Conclusions:Increases in the intensity of services offered per mental health patient at FQHCs-rather than increases in overall capacity-may reduce African American youthʼs overreliance on the ED for psychiatric care.

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“…The difference may also reflect the nature of our national system of CHCs. Patient populations at CHCs generally have more physical and mental health comorbidity 15 , 30 , 31 and have a lower income compared with the general population. 15 Despite this complexity, CHCs surpass private clinics in many quality metrics, 15 , 32 , 33 and there may be a heightened clinician awareness and attention to opioid quality initiatives in CHCs compared with private clinics.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

et al. 2020

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IMPORTANCE Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioidrelated harms. OBJECTIVE To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis. MAIN OUTCOMES AND MEASURES The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users. RESULTS The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.

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Rapid Growth of Mental Health Services at Community Health Centers

Cited by 18 publications

References 28 publications

Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

Psychiatric‐related Revisits to the Emergency Department Following Rapid Expansion of Community Mental Health Services

African American/white disparities in psychiatric emergencies among youth following rapid expansion of Federally Qualified Health Centers

Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

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