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Characteristics of patients with substance use disorder before and after the Affordable Care Act.
Drug Alcohol Depend. 2018 12 01; 193:124-130.DA

Abstract

BACKGROUND

The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation.

METHODS

In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures.

RESULTS

Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans.

CONCLUSIONS

Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.

Authors+Show Affiliations

Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA. Electronic address: cynthia.i.campbell@kp.org.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA.Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30366189

Citation

Campbell, Cynthia I., et al. "Characteristics of Patients With Substance Use Disorder Before and After the Affordable Care Act." Drug and Alcohol Dependence, vol. 193, 2018, pp. 124-130.
Campbell CI, Parthasarathy S, Altschuler A, et al. Characteristics of patients with substance use disorder before and after the Affordable Care Act. Drug Alcohol Depend. 2018;193:124-130.
Campbell, C. I., Parthasarathy, S., Altschuler, A., Young-Wolff, K. C., & Satre, D. D. (2018). Characteristics of patients with substance use disorder before and after the Affordable Care Act. Drug and Alcohol Dependence, 193, 124-130. https://doi.org/10.1016/j.drugalcdep.2018.08.028
Campbell CI, et al. Characteristics of Patients With Substance Use Disorder Before and After the Affordable Care Act. Drug Alcohol Depend. 2018 12 1;193:124-130. PubMed PMID: 30366189.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics of patients with substance use disorder before and after the Affordable Care Act. AU - Campbell,Cynthia I, AU - Parthasarathy,Sujaya, AU - Altschuler,Andrea, AU - Young-Wolff,Kelly C, AU - Satre,Derek D, Y1 - 2018/10/06/ PY - 2018/04/20/received PY - 2018/08/14/revised PY - 2018/08/16/accepted PY - 2018/10/27/pubmed PY - 2019/3/16/medline PY - 2018/10/27/entrez KW - Affordable Care Act KW - Electronic health record KW - Health Insurance KW - Mixed methods KW - Substance use disorder SP - 124 EP - 130 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 193 N2 - BACKGROUND: The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation. METHODS: In this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures. RESULTS: Interviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans. CONCLUSIONS: Post-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/30366189/Characteristics_of_patients_with_substance_use_disorder_before_and_after_the_Affordable_Care_Act_ DB - PRIME DP - Unbound Medicine ER -