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21. Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making.

Author

Bhardwaj, Anvita, Sousa, Jessica L., Huskamp, Haiden A., Busch, Alisa B., Kennedy-Hendricks, Alene, Hodgkin, Dominic, Horgan, Constance, and Uscher-Pines, Lori

Abstract

PURPOSE Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD) that can be prescribed within primary care, they are underutilized. We aimed to explore how primary care physicians familiar with MAUD make prescribing decisions and to identify reasons for underuse of MAUD within primary care. METHODS We conducted semistructured interviews with 19 primary care physicians recruited from a large online database of medical professionals. Physicians had to have started a patient on MAUD within the last 6 months in an outpatient setting. Inductive and deductive thematic analysis was informed by the theory of planned behavior. RESULTS Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. To make MAUD prescribing a smaller component of their practice, physicians reported applying various rules of thumb to select patients for MAUD. These included recommending MAUD to the patients who seemed the most motivated to reduce drinking, those with the most severe AUD, and those who were also receiving other treatments for AUD. CONCLUSIONS There is a challenging implementation context for MAUD due to competing demands within primary care. Future research should explore which strategies for identifying a subset of patients for MAUD are the most appropriate and most likely to improve population health and health equity. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Health services and financing of treatment

Author

Stewart, Maureen T. and Horgan, Constance M.

Subjects
Health insurance industry -- Finance -- Services, Drug treatment centers -- Services, Medicaid -- Laws, regulations and rules, Substance abuse -- Care and treatment, Government regulation, Company business management, Company financing, Health
Abstract

FINANCING OF ALCOHOL AND OTHER DRUG TREATMENT Although most general medical services are paid for through private and public insurance mechanisms, insurance coverage has traditionally played a smaller role in [...]

Published
2011

42. Hispanics in specialty treatment for substance use disorders

Author

Reif, Sharon, Horgan, Constance M., and Ritter, Grant A.

Subjects
Hispanic Americans -- Social aspects, Hispanic Americans -- Behavior, Health counseling -- Methods, Health counseling -- Demographic aspects, Substance abuse -- Care and treatment, Substance abuse -- Methods, Substance abuse -- Demographic aspects, Law, Psychology and mental health, Sociology and social work
Abstract

With the growing number of Hispanics in the U.S. and the accompanying growing number of Hispanic clients in the specialty substance abuse treatment system, it is increasingly pertinent to ensure that they receive appropriate and relevant treatment for substance use disorders. We use nationally representative data to determine the sociodemographic, substance use, mental health, and treatment characteristics of Hispanic clients in specialty substance abuse treatment, as compared to nonHispanic clients. Hispanic clients are in treatment more often for heroin use and are referred to treatment more often by the criminal justice system. More White clients receive individual counseling than Hispanic clients. Hispanic clients have fewer co-occurring mental disorders than White clients, but a similar history of mental health treatment. These findings set the stage for refining the agenda to develop the most effective treatments for Hispanics with substance use disorders.

Published
2008

44. Are Washington Circle performance measures associated with decreased criminal activity following treatment?

Author

Garnick, Deborah W., Horgan, Constance M., Lee, Margaret T., Panas, Lee, Ritter, Grant A., Davis, Steve, Leeper, Tracy, Moore, Rebecca, and Reynolds, Mark

Subjects
Patient compliance -- Influence, Imprisonment -- Evaluation, Substance abuse -- Care and treatment, Substance abuse -- Methods, Health
Abstract

This study examines the association between adherence to during-treatment process measures of quality (defined as initiation and engagement in treatment as developed by the Washington Circle) and outcome measures (defined as arrests and incarcerations) in the following year. The data come from the Oklahoma Department of Mental Health and Substance Abuse Services administrative data system linked to data from state criminal justice agencies. Clients who initiated a new episode of outpatient treatment and who engaged in treatment were significantly less likely to be arrested or incarcerated in the following year. Initiation of substance abuse treatment alone, without engagement in treatment, was not significantly associated with arrests or incarcerations. These findings validate the clinical importance of the Washington Circle performance measures of initiation and engagement. Applying the 'process-of-care' measures can make a difference when they are used as a target for quality improvement in treatment facilities. Keywords: Substance abuse treatment; Performance measures; Outcomes; Treatment initiation; Treatment engagement

Published
2007

47. Performance measures for alcohol and other drug services

Author

Garnick, Deborah W., Horgan, Constance M., and Chalk, Mady

Subjects
Pharmaceutical industry, Substance abuse -- Care and treatment, Health, Care and treatment
Abstract

Performance measures, which evaluate how well health care practitioners' actions conform to practice guidelines, medical review criteria, or standards of quality, can be used to improve access to treatment and [...]

Published
2006

48. Incentive effects on cooperation rates and sample composition in the alcohol and drug services study

Author

Ritter, Grant, Reif, Sharon, Gadzuk, Anita, Krenzke, Thomas, Mohadjer, Leyla, Lee, Margaret, and Horgan, Constance M.

Subjects
Conditioned response -- Analysis, Incentives (Business) -- Forecasts and trends, Incentives (Business) -- Analysis, Statistical sampling -- Usage, Statistical sampling -- Analysis, Market trend/market analysis, Economics, Sociology and social work
Abstract

In the past, incentive payments have proven successful in increasing survey response rates. In particular, incentives have been shown to increase the yield rate for harder-to-interview respondents. Despite this success, incentives are not without controversy. Opponents note that incentives may make the survey appear less important, destroy civic responsibility, and create an unnecessary expectation, Over time researchers may have to pay sizable incentives to achieve the response rates obtained 20 years ago before the use of incentives was common. Incentives could also have a detrimental impact on sample composition. The Alcohol and Drug Services Study (ADSS) included an incentive payment sub-study as part of its client follow-up phase. The sample for this sub-study randomized clients into four groups. One group was paid $25, the amount received by other responding clients in the ADSS main study. Respondents in the other three groups were paid an alternative amount (i.e., $0, $10, or $35). In examining the impact of varying incentives to sampling benchmarks, such as response rate and sample composition, the ADSS incentive sub-study found that the fears of opponents concerning the use of incentives were substantially unfounded, at least among the substance abuse treatment clients in the follow-up phase of ADSS.

Published
2005

50. Establishing the feasibility of performance measures for alcohol and other drugs

Author

Garnick, Deborah W., Lee, Margaret T., Chalk, Mady, Gastfriend, David, Horgan, Constance M., McCorry, Frank, McLellan, A. Thomas, and Merrick, Elizabeth Levy

Subjects
Managed care plans (Medical care) -- Evaluation, Alcoholism -- Care and treatment, Drug abuse -- Care and treatment, Health
Abstract

The Washington Circle (a multi-disciplinary group of providers, researchers, managed care representatives, and public policy representatives) examined three performance measures for alcohol and other drug (AOD) services. These measures, which were developed and applied to managed care organizations' administrative data for their commercial enrollees, are: (a) identification, the percent of adult enrollees with AOD diagnoses; (b) initiation, the percent of adults with an inpatient AOD admission or with an index outpatient visit for AOD abuse or dependence and any additional AOD services within 14 days of identification; and (c) engagement, the percent of adults diagnosed with AOD disorders that receives two additional AOD services within 30 days of the initiation of care. We conclude that using administrative databases to compare managed care organizations' performance is feasible, meaningful and informative. The article discusses issues in interpreting performance measures in several areas: organizational structure of alcohol and other drug services, information available for measurement, and computational issues. Keywords: Performance; Identification; Engagement; Initiation; Measurement

Published
2002

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