Research Roundup: Retail Clinics; Medicaid And Access To Doctors; Mental Health Coverage
Each week, KHN compiles a selection of recently released health policy studies and briefs.
The New England Journal of Medicine:
Convenient Ambulatory Care — Promise, Pitfalls, And Policy
Both retail clinics and urgent care centers are part of the rapidly growing “convenient care” industry .... This article aims to ... examine the evidence of their effect on cost, quality, access, patient navigation, and continuity of care; to discuss existing standards and regulatory approaches; and finally to lay out the key policy considerations in balancing support for these new care models while ensuring essential protections for patients. ... Convenient ambulatory care poses a double-edged sword for policymakers. On one hand, assisting their growth could help address the imperative to reduce cost while increasing access to care. On the other hand, concerns about quality, the potential to mislead patients in need of higher levels of care, and fragmentation of care call for regulatory safeguards for patients. (Chang, Brundage and Chokshi, 7/23)
JAMA Pediatrics:
Geographic Variation In Hospitalization For Lower Respiratory Tract Infections Across One County
Bronchiolitis and pneumonia are leading causes of pediatric hospitalizations. Identifying geographic patterns in hospitalization rates across small geographic areas could be particularly relevant to targeted patient-level and population-level health care. ...We calculated bronchiolitis and pneumonia hospitalization rates for Hamilton County [Ohio] and for each of 222 in-county census tracts [between January 1, 2010, and December 31, 2013]. ... Bronchiolitis and pneumonia hospitalization rates varied considerably in ways that were related to underlying socioeconomic conditions. Clinical and public health interventions, targeted accordingly, could improve patient-level and population-level management of acute conditions at a reduced cost. (Beck et al., 7/20)
Health Affairs:
Primary Care Appointment Availability For New Medicaid Patients Increased After Medicaid Expansion In Michigan
We conducted a simulated patient (or “secret shopper”) study to assess primary care appointment availability and wait times for new patients with Medicaid or private insurance before and after implementation of Michigan’s Medicaid expansion in 2014. The expansion, which was made possible through a section 1115 waiver, has a unique requirement that new beneficiaries must be seen by a primary care provider within 60–90 days of enrollment. During a period of rapid coverage expansion in Michigan, we found that appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients, compared to availability before the expansion. Wait times remained stable, at 1–2 weeks for both groups. (Tipirneni et al., 7/22)
GAO:
Behavioral Health: Options For Low-Income Adults To Receive Treatment In Selected States
GAO was asked to provide information about access to behavioral health treatment for low-income, uninsured, and Medicaid-enrolled adults. ... GAO also selected [to review] four non-expansion and six expansion states ....Behavioral health agencies (BHA) in four selected non-expansion states offered various treatment options for low-income, uninsured adults, focusing care primarily on those with the most serious behavioral health needs. ... [They] established priority populations of those with the most serious behavioral health needs [and] in three of the four states maintained waiting lists for adults with less serious behavioral health needs. [In the six states that expanded Medicaid] ... officials reported increased availability of behavioral health treatment, although some access concerns continue. Four of the six selected states explicitly chose separate contractual arrangements for behavioral health and physical benefits. (7/20)
Psychiatric Services/Rand Corp.:
Noncommissioned Officers' Perspectives On Identifying, Caring For, And Referring Soldiers And Marines At Risk Of Suicide
Noncommissioned officers (NCOs) in the U.S. Army and U.S. Marine Corps were surveyed to identify their ability and willingness to identify, intervene on behalf of, and refer fellow soldiers and marines at risk of suicide. ... Thirty-seven percent of marines and 40% of Army soldiers reported that they could use more suicide prevention training. Compared with trained civilians, NCOs reported greater efficacy to intervene with at-risk peers, but they also reported relatively more reluctance to intervene. Close to 40% of NCOs believed that they would be held responsible for a service member’s suicide if they had asked the service member about suicidal thoughts before the suicide occurred. Chaplains were the preferred referral source, primarily because of the confidentiality they afford. (Ramchand et al., July, 2015)
Georgetown University Health Policy Institute/NORC at the University of Chicago/The Kaiser Family Foundation:
To Switch Or Be Switched: Examining Changes In Drug Plan Enrollment Among Medicare Part D Low-Income Subsidy Enrollees
Low-income [Medicare] beneficiaries who receive premium and cost-sharing assistance through the Part D Low-Income Subsidy (LIS) program have a subset of premium-free [prescription drug plans] PDPs (benchmark plans) available to them, but can also choose to enroll in a non-benchmark plan and pay a premium. ... When PDPs lose their premium-free status, the Centers for Medicare & Medicaid Services (CMS) automatically reassigns many of their LIS enrollees to another premium-free PDP; however, CMS does not reassign LIS enrollees who have chosen a plan other than their assigned PDP. ... The CMS policy for determining which LIS enrollees will be automatically reassigned ... has shielded many low-income beneficiaries ... but as our analysis shows, it has the potential to reduce the financial protection available ... for the share of LIS enrollees who have chosen their own plans. (Hoadley et al., 7/17)
Here is a selection of news coverage of other recent research:
The New York Times:
Chemotherapy May Worsen End-Of-Life Quality, Study Finds
It is an excruciating question for cancer patients with a prognosis of only months to live. Should they try another round of chemotherapy? ... Now, a new study suggests that even those stronger patients may not benefit from end-of-life chemotherapy — and that for many their quality of life may worsen in their final weeks compared with patients who forego last-ditch treatment. “It worsened quality of life for those that are relatively healthy, and those are the ones that the guidelines support treating,” said Dr. Charles Blanke, a medical oncologist at Oregon Health and Science University, who was not involved in the study. “Chemotherapy is supposed to either help people live better or help them live longer, and this study showed that chemotherapy did neither.” (Belluck, 7/23)
NPR:
With Pap Tests Less Common, Women May Miss Out On STD Tests
Changes in how women are screened for cervical cancer mean they're getting Pap tests less often. But that may also mean young women are not getting tested for chlamydia, the most common sexually transmitted disease. As the number of teens and young women getting annual Pap tests declined, so did the number getting screened for chlamydia, according to a study published Monday in Annals of Family Medicine. (Yang, 7/21)
The Wall Street Journal:
Pregnant Women Get More Ultrasounds, Without Clear Medical Need
In 2014, usage in the U.S. of the most common fetal-ultrasound procedures averaged 5.2 per delivery, up 92% from 2004, according to an analysis of data compiled for The Wall Street Journal by FAIR Health Inc., a nonprofit aggregator of insurance claims. Some women report getting scans at every doctor visit during pregnancy. But medical experts are now warning that frequent scans in low-risk pregnancies aren’t medically justified. A joint statement in May 2014 from several medical societies, including the American College of Obstetricians and Gynecologists, calls for one or two ultrasounds in low-risk, complication-free pregnancies. (Helliker, 7/17)
Medscape:
Antibiotic Use Climbs For Acute Respiratory Infections
Antibiotic use, particularly of macrolides, increased among veterans with acute respiratory infections over the course of 6 years, according to a retrospective, cross-sectional study. Moreover, providers accounted for nearly 60% of the variation in prescription rates. The authors note that their findings, published in the July 21 issue of the Annals of Internal Medicine, mirror similar findings in other national studies, including ones using data from the National Ambulatory Medical Care Survey. (Haelle, 7/21)
Reuters:
Families On Medicaid Make More Incorrect Assumptions About Antibiotics
Parents of children insured by Medicaid, the U.S. health program for the poor, are more likely to incorrectly assume antibiotics can treat colds and flu and seek these drugs when kids don’t actually need them, a study suggests. Parents surveyed in Massachusetts reported using antibiotics for their kids on average less than once a year, the study found. But when asked if antibiotics should be used for colds of flu, only 44 percent of the Medicaid parents correctly said “no,” compared with 78 percent of parents with private coverage. (Rapaport, 7/20)
Reuters:
Effect Of Poverty On Brains May Explain Poor Kids' Lower Test Scores
The effect of poverty on children’s brains may explain why poor youngsters tend to score lower on standardized tests compared to wealthier students, a new study suggests. ... [Seth] Pollak, from the University of Wisconsin-Madison, and colleagues report in JAMA Pediatrics that about 20 percent of the gap in test scores between poor children and middle-class children may be a result of poor brain development in the upper-front and side regions of the brain known as the frontal and temporal lobes, respectively. The researchers examined brain images and standardized test scores from 389 children and young adults, ages four to 22, participating in a study by the U.S. National Institutes of Health between 2001 and 2007. (Seaman, 7/20)
The New York Times:
Not Telling Your Doctor You Use Acupuncture And Chiropractic
People with chronic back, neck or joint pain commonly seek acupuncture and chiropractic care for relief, but many don’t tell their doctors about it, a new study reports. Researchers said they were surprised to find that of some 6,068 chronic pain patients who responded to a questionnaire, 47 percent reported using chiropractic care, 32 percent said they used acupuncture, and 21 percent used both. (Rabin, 7/23)
The Associated Press:
Report: Teen Use Of Morning-After Pill Is Climbing
More than 1 in 5 sexually active teen girls have used the morning-after pill — a dramatic increase that likely reflects that it’s easier now for teens to buy the emergency contraceptive. A report released Wednesday shows teen use of the morning-after pill rose steadily from a decade earlier, when it was 1 in 12. Now, all teens can buy it without a prescription. The finding comes from a Centers for Disease Control and Prevention survey that’s considered the government’s best source of information on teen sex and contraception use. (Stobbe, 7/21)
Reuters:
Many Vietnam Veterans Have PTSD 40 Years After War
Decades after the end of the U.S. war in Vietnam, more than one in ten American veterans from the conflict still experience at least some symptoms of post traumatic stress disorder (PTSD), according to a new study. One third of veterans with PTSD also suffer from major depressive disorder, the research team reports in JAMA Psychiatry. (Rapaport, 7/22)