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- Title
Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus.
- Authors
Santos, Tatiane; Bergman, Alon; Smith-McLallen, Aaron
- Abstract
This cohort study examines whether participation in the Centers for Medicare & Medicaid Services' Comprehensive Primary Care Plus model was associated with improved access to mental health and substance use treatment. Key Points: Question: Was the Comprehensive Primary Care Plus (CPC+) demonstration associated with improved access to mental health and substance use services? Findings: In this cohort study of 188 770 adults with anxiety, depression, or opioid use disorder (OUD), findings were mixed. Individuals with OUD who received care at CPC+ practices filled more buprenorphine and anxiolytic prescriptions than those receiving care at non-CPC+ practices. Meaning: Findings of this study suggest that integration of behavioral health in primary care may improve access to mental health and substance use treatment, especially for individuals with OUD. Importance: To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective: To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants: Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure: Receipt of care at a practice participating in CPC+. Main Outcomes and Measures: Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results: The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance: Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.
- Subjects
PENNSYLVANIA; UNITED States; SUBSTANCE abuse treatment; METHADONE treatment programs; MENTAL illness treatment; HEALTH services accessibility; DUAL diagnosis; MENTAL health services; HUMAN services programs; RESEARCH funding; PRIMARY health care; MEDICARE; HEALTH policy; RETROSPECTIVE studies; TRANQUILIZING drugs; ANXIETY; DESCRIPTIVE statistics; LONGITUDINAL method; ANTIDEPRESSANTS; MEDICAL emergencies; NARCOTICS; QUALITY of life; MEDICAID; CLINICS; PUBLIC health; COMPARATIVE studies; CONFIDENCE intervals; COVID-19 pandemic; INTEGRATED health care delivery; INSURANCE companies; MENTAL depression; BUPRENORPHINE
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe248519
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8519