Biomedical subjects

Usha Sambamoorthi

Publications and source records attributed to Usha Sambamoorthi.

At least 19 recordsLinked to original sources

PubMed2006

Initial nontraumatic lower-extremity amputations among veterans with diabetes.

RESEARCH OBJECTIVE: We sought to identify initial nontraumatic lower-extremity amputations (ILEAs) and compare rates of ILEAs with different coding algorithms and varying lengths of observation period prior (look-back) to the first observed amputation. STUDY DESIGN: We used a retrospective design on merged Medicare claims and patient treatment files of the Veteran Healthcare Administration for fiscal years 1998 to 2000 of veterans with diabetes ages 18 years and older. Three different algorithms using least-inclusive to most-inclusive procedure codes and "look-back" periods of 12, 18, and 24 months were used to identify ILEAs. FINDINGS: Overall, 2997 (8.2 per 1000) veterans experienced an amputation in fiscal year 2000. Using 24 months of previous data, the rates of ILEA under the 3 different algorithms I, II, and III were 6.4/1000, 6.2/1000, and 6.0/1000 respectively. Using the most stringent algorithm (III), ILEA rates were 6.6/1000 with 12 months of prior data, 6.2/1000 with 18 months of prior data. Compared with any amputations in fiscal year 2000, 12-, 18-, and 24-month look-back period decreased the ILEA rates by 19%, 24%, and 27%, respectively. CONCLUSION: These findings highlight the usefulness of administrative data in identifying ILEAs. All 3 algorithms performed comparably well in the detection of ILEAs. The extent of identification was most complete with 24 months prior data, with marginal gains in extending the prior observation period from 18 to 24 months. Policy level analysis should consider reporting ILEAs, in addition to total amputation rates when examining trends and disparities in amputations.

Adult↗

PubMed2006

Are there gender differences in diabetes care among elderly Medicare enrolled veterans?

OBJECTIVE: To examine gender differences in diabetes care process measures and intermediate outcomes among veteran clinic users. DESIGN: A retrospective cohort study using Veterans Health Administration (VHA) and Medicare files of VHA clinic users with diabetes. Diabetes care process measures were tests for hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C) values, and eye exams. Intermediate outcomes were HbA1c and LDL-C values below recommended thresholds. Chi-square tests and logistic regressions were used to assess gender differences. PARTICIPANTS: Study population included 3,225 women and 231,922 men veterans with diabetes, enrolled in Medicare fee-for-service and alive at the end of fiscal year 2000. RESULTS: Overall, there were no significant gender differences in HbA1c or LDL-C testing. However, women had higher rates in these process measures than men among the non-African American minorities. Women were more likely to have completed eye exams (odds ratio [OR]=1.11; 99% confidence interval [CI]=1.10, 1.23) but were less likely to have LDL-C under 130 mg/dL (OR=0.77; 99% CI=0.69, 0.87). CONCLUSIONS: Among VHA patients with diabetes, clinically significant gender inequality was not apparent in most of diabetes care measures. However, there was evidence of better care among nonwhite and non-African American women than their male counterparts. Further research on interaction of race and gender on diabetes care is needed. This includes evaluation of integrated VHA women's health programs as well as cultural issues. Lower LDL-C control among women suggests areas of unmet needs for women and opportunities for future targeted quality improvement interventions at system and provider levels.

Aged↗

PubMed2006

Diabetes and depression care among medicaid beneficiaries.

This study evaluates the relationship between diabetes mellitus and depression care among non-elderly Medicaid beneficiaries, using claims data from the 1995 State Medicaid Research Files for Alabama, Georgia, New Jersey, and Wisconsin. Presence of comorbid diabetes was found to be significantly associated with a higher rate of depression diagnosis. Among those who were diagnosed as depressed, treatment of comorbid diabetes was associated with a higher rate of antidepressant treatment than among depression-diagnosed patients who did not also have diabetes. However, among patients with diabetes and depression, a quarter received only tricyclic antidepressants. Controlling for other characteristics, African Americans diagnosed with depression were less likely to receive antidepressant treatment and, if they did receive such treatment, more likely to receive the older tricyclic drugs. These findings raise concern for glycemic control among patients with diabetes and depression treated with tricyclic antidepressants in a low-income Medicaid population. Among depressed Medicaid beneficiaries with diabetes, there are racial differences with regard to quality of mental health care in the presence of diabetes.

Adolescent↗

PubMed2005

Mental illness, traumatic brain injury, and medicaid expenditures.

OBJECTIVE: To estimate the rates of mental illness among Medicaid beneficiaries with traumatic brain injury (TBI) and associated Medicaid-paid expenditures. DESIGN: Retrospective claims-based calendar year data. SETTING: Claims data. PARTICIPANTS: Medicaid recipients with diagnosed TBI and mental illness who received Medicaid services in 4 states in 1995. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Annual expenditures for total, inpatient, and noninpatient services, as derived from Medicaid personal summary files. Mental illness and TBI were identified by using International Classification of Diseases, 9th Revision , Clinical Modification codes recorded in Medicaid claims. RESULTS: Of a total of 493,663 Medicaid recipients, 3641 (0.7%) were diagnosed with TBI in the 4 states. Significant demographic and racial differences were found in the rates of TBI; 18% of patients with TBI were diagnosed with serious mental illness. People with TBI in the age group 40 to 49 years were more likely to have a mental disorder. There were significant differences in estimated total, inpatient, and noninpatient expenditures between those with and without mental illness. In general, those with serious mental illness had higher Medicaid-paid expenditures than those without any mental illness. CONCLUSIONS: Psychiatric comorbidity in TBI increases the overall expenditures in this population. This increased cost is an important consideration in programming for those with TBI.

Adult↗

PubMed2005

Who are the elderly who never receive influenza immunization?

OBJECTIVE: This paper estimates the rates of lifetime nonreceipt of influenza immunization among elderly and examines variations in the lifetime nonreceipt of immunization by gender, race and ethnic group, socioeconomic status, access to health care, and health status. METHODS: Cross-sectional, nationally representative data on 5557 adults older than 50 years of age and living in the community from the 2000 Medical Expenditure Panel Survey are used. Lifetime nonreceipt of influenza immunization was analyzed with bivariate and multivariate statistical techniques. FINDINGS: Thirty-one percent of the elderly reported never receiving influenza immunization and 20% reported irregular immunization. Higher odds of lifetime nonreceipt of vaccination and irregular vaccination were seen among African-Americans, young-old, current smokers, and those with no usual source of care. CONCLUSIONS: Future campaigns to increase immunization rates should be tailored to target this hard-to-reach group of individuals.

Aged↗

PubMed2005

Use of psychotherapy for depression in older adults.

OBJECTIVE: The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment. METHOD: Linked Medicare claims and survey data from the 1992-1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency. RESULTS: The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients' socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy. CONCLUSIONS: Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults.

Age Factors↗

PubMed2004

Use of antipsychotic medications among HIV-infected individuals with schizophrenia.

Persons with schizophrenia face elevated risk of infection with HIV. While HIV therapy is demanding, patients diagnosed with both conditions also require appropriate and consistent management of their psychiatric illness, for the same reasons that generally apply to persons with schizophrenia and because untreated psychiatric illness can interfere with full participation in HIV care. This study examines the correlates of use of and persistence on antipsychotic medications among HIV-infected individuals with schizophrenia, using merged New Jersey HIV/AIDS surveillance data and paid Medicaid claims. Persistence was defined as at least 2 months of medication use in a quarter. We identified 350 individuals who were dually diagnosed with HIV and schizophrenia. Overall, 81% of these beneficiaries had at least one claim for an antipsychotic medication at some point between 1992 and 1998. Multivariate techniques were used, including simple logistic regressions on use and robust longitudinal regressions that controlled for repeated observations on the same individual and treatment gaps. Among users of antipsychotic medications, persistence was very low at 37%. Racial/ethnic minorities were less likely to receive atypical antipsychotic medications. Use of atypical antipsychotics was associated with higher persistence. Our study confirmed past findings of racial disparities in the receipt of atypical antipsychotic medications. Findings suggest that use of atypical medications may benefit individuals dually diagnosed with HIV and serious mental illness.

Adolescent↗

PubMed2004

Characteristics of community dwelling elderly not vaccinated for pneumococcus in 1998 and 2001.

BACKGROUND: We estimate proportions and numbers of elderly (>65 years old) not vaccinated for pneumococcus in 1998 and 2001 by ethnic group, socioeconomic status, health history, and access and use of health care. METHODS: Self-reported lifetime pneumococcal vaccination and participant characteristics were obtained from 10,624 community dwelling elderly in the 1998 and 2001 National Health Interview Surveys (NHIS). Robust descriptive and inferential statistical analyses were fit. Outcome. Non-receipt of pneumococcal vaccination. RESULTS: In 2001, about 13 million (or 45% of all) community dwelling elderly were unvaccinated against pneumococcus, including 11.5 million who saw a doctor at least once, 4 million who received an influenza vaccination and 2.3 million who were hospitalized, during the previous year. In 1998 and 2001 non-US born, Hispanic, African-American, and Medicaid recipient elderly were disproportionately un-vaccinated, with about 65% of each group not vaccinated in 2001. CONCLUSIONS: In 2001, lifetime pneumonia vaccination of community dwelling elderly (55%) was below the goal (60%) for Healthy People 2000. While there has been important progress in improving overall vaccination rates, much more needs to be done to attain national goals and reduce large, persistent racial/ethnic and socioeconomic disparities. Lack of a usual source of healthcare and lower frequency of physician visits were among the factors associated with non-vaccination. However, most unvaccinated individuals had seen a physician in the last year, and many had received influenza vaccination or been hospitalized, suggesting the need for more consistent implementation and monitoring of guidelines for routine pneumococcal vaccination in healthcare settings.

Aged↗

PubMed2004

Employment and disability: evidence from the 1996 medical expenditures panel survey.

The relationship between employment and disability has gained national attention, as the ability to maintain employment is inconsistent among those with limitations. This cross-sectional study of employment among individuals (N = 1691, age 21-62 years) with self-reported limitations in the 1996 Medical Expenditures Panel Survey seeks to identify predictors of employment despite physical and/or cognitive limitations. Two predictive models of employment including 10 variables are explored; 1 included insurance (chi2 = 3856.85, p < or = 0.00) and the other removed the insurance variable (chi2 = 280.21, p < or = 0.00). Individuals with limitations who are employed are more likely to have a college-level education, have better physical and mental health perceptions and have private insurance. This analysis demonstrates that people do work despite reported activity, functional or sensory limitations and that socioeconomic factors are crucial in why someone is able to attain employment.

Adult↗

PubMed2004

Sensitivity of an AIDS case-finding algorithm: who are we missing?

OBJECTIVE: The objective of this study was to determine the sensitivity of an AIDS case-finding algorithm. METHOD: This study applied the AIDS case-finding algorithm to paid Medicaid claims linked to New Jersey AIDS surveillance data and assesses its sensitivity across subgroups of patients. FINDINGS: Of the 7183 cases with confirmed AIDS, based on the state's registry information, 95% (n = 6818) were correctly detected using all Medicaid claims, including pharmacy. For patients in a community-based waiver program, covered by Medicare, diagnosed with a severe mental illness, or continuously enrolled in Medicaid, with regular contact with the medical system, the algorithm identified almost all patients. To further evaluate algorithm performance, it was used with 2 groups of interest to researchers. For AIDS patients in the last 6 months of life, 88% were correctly detected without use of pharmacy claims and 95% when pharmacy claims were included. For pregnant women, data from the 6 months before the latest delivery date identify 27% of pregnant women without pharmacy claims and 41% when pharmacy claims were included. Using claims made after the latest delivery date, 81% of pregnant women were detected without pharmacy claims and 93% when pharmacy claims were included CONCLUSION: Results demonstrate that a multilevel screen can be used with Medicaid claims to effectively to detect most patients with AIDS. Detection is lower for some subgroups, and the absence of pharmacy claims can compromise detection.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Mental illness and length of inpatient stay for medicaid recipients with AIDS.

OBJECTIVE: To examine the associations between comorbid mental illness and length of hospital stays (LOS) among Medicaid beneficiaries with AIDS. DATA SOURCE AND COLLECTION/STUDY SETTING: Merged 1992-1998 Medicaid claims and AIDS surveillance data obtained from the State of New Jersey for adults with >or=1 inpatient stay after an AIDS diagnosis from 1992 to 1996. STUDY DESIGN: Observational study of 6,247 AIDS patients with 24,975 inpatient visits. Severe mental illness (SMI) and other less severe mental illness (OMI) diagnoses at visits were ascertained from ICD-9 Codes. About 4 percent of visits had an SMI diagnosis; 5 percent had an OMI diagnosis; 43 percent did not have a mental illness diagnosis, but were patients who had been identified as having an SMI or OMI history; and 48 percent were from patients with no identified history of mental illness. PRINCIPAL FINDINGS: The overall mean hospital LOS was 12.7 days. After adjusting for measures of HIV disease severity and health care access in multivariate models, patients presenting with primary and secondary severe mental illness (SMI) diagnoses had approximately 32 percent and approximately 11 percent longer LOS, respectively, than did similar patients without a mental illness history (p<0.001 for each). But in these adjusted models of length of stay: (1) diagnosis of OMI was not related to LOS, and (2) in the absence of a mental illness diagnosed at the visit, an identified history of either SMI or OMI was also not related to LOS. In adjusted models of time to readmission for a new visit, current diagnosis of SMI or OMI and in the absences of a current diagnosis, history of SMI or OMI all tended to be associated with quicker readmission. CONCLUSIONS: This study finds greater (adjusted) LOS for AIDS patients diagnosed with severe mental illness (but not for those diagnosed with less severe mental comorbidity) at a visit. The effect of acute severe mental illness on hospitalization time may be comparable to that of an acute AIDS opportunistic illness. While previous research raises concerns that mental illness increases LOS by interfering with treatment of HIV conditions, the associations here may simply indicate that extra time is needed to treat severe mental illnesses or arrange for discharge of afflicted patients.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Use of newer antiretroviral treatments among HIV-infected medicaid beneficiaries with serious mental illness.

OBJECTIVES: The study compares rates of protease inhibitor (PI) use during the 3 years following the introduction of these newer treatments among human immunodeficiency virus (HIV)-infected individuals with and without serious mental illness and examines persistence of use of these therapies across these subgroups. METHOD: We used merged autoimmune deficiency syndrome (AIDS)/HIV surveillance and Medicaid claims data to examine use of PIs and non-nucleoside reverse transcriptase inhibitors (NNRTIs) among New Jersey Medicaid beneficiaries with AIDS between 1996 and 1998. Based on the ICD-9-CM diagnoses assigned by a high-credibility source in 1 inpatient or 2 outpatient claims, we identified patients with schizophrenia (ICD-9-CM code 295) and those with severe affective disorder (combining patients with recurrent major depressive disorder [ICD-9-CM code 296.3] or bipolar disorder [296.4, 296.5, 296.6, 296.7, or 296.8]). These groups were compared with those patients with no serious mental illness. RESULTS: In this sample, patients with schizophrenia (68.3%) and those with severe affective disorder (75.6%) were more likely to have initiated new antiretroviral therapy than were those without serious mental illness (64.3%). Patients with severe affective disorder, but not those with schizophrenia, were significantly less persistent (p <.01) in their use of PI/NNRTI therapy than those without serious mental illness. CONCLUSIONS: No evidence was found that the presence of a serious mental illness discourages physicians from initiating new antiretroviral therapy, perhaps reflecting a comparatively high level of integration of these patients into the health care system. Patients with schizophrenia are as persistent in their use of PI/NNRTI therapy as those without a serious mental illness. Lower rates of medication compliance by those with severe affective disorder justify increased efforts to support optimal adherence.

Acquired Immunodeficiency Syndrome↗

PubMed2003

The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life.

The objectives of this study were to provide a national profile of socioeconomic circumstances of the middle-aged and older population living with HIV and to evaluate variations in social support and quality of life (QOL) across age and socioeconomic subgroups, controlling for indicators of disease progression. The design used was a cross-sectional analysis of nationally representative interview data on HIV-infected individuals collected in the HIV Cost and Services Utilization Study. Multiple measures of social support and QOL were used. Bivariate comparisons of outcomes across categories of age and exposure category were performed; multivariate analyses to isolate the effect of older age on outcomes within exposure categories were performed, controlling for socioeconomic and clinical co-variates. Study results indicate that older gay men with HIV/AIDS are a predominantly white population and more likely to have health insurance than their younger counterparts; 38% were employed and 48% reported incomes of more than $25,000. Older injection drug users (IDUs) with HIV/AIDS are a predominantly black population with a particularly high concentration of disadvantages; only 11% were employed and 74% reported incomes of less than $10,000. Older IDUs reported especially low levels of physical functioning and emotional support in comparison with their younger counterparts, whereas older gay men did not significantly differ from younger gay men in these respects. The authors conclude that characteristics and care needs of the older HIV-positive population are very diverse and vary sharply by exposure route. Interventions need to be tailored to the needs of these distinct subpopulations, with an emphasis on development of supportive care interventions for older IDUs.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women.

BACKGROUND: In this article we estimate the variations in receipt of age-appropriate preventive services among adult women between 21 and 64 years of age, by race and ethnic group, socioeconomic status, and access to health care. We also assess whether differences in access to care and socioeconomic status may explain racial and ethnic differences in the use of preventive services. METHOD: Nationally representative data on adult women from the Medical Expenditure Panel Survey were used to estimate the effect of socioeconomic characteristics on the receipt of each preventive service. Receipt of each of four preventive services-cholesterol test, blood pressure reading, and two cancer screening tests (Papanicolaou smear, mammogram)-according to the 1996 recommendations of the U.S. Preventive Services Task Force were examined. RESULTS: An overwhelming majority of adult women (93%) had had a blood pressure reading within the last 2 years. Eighty-four percent of women had had their cholesterol checked within the last 5 years. Seventy-five percent of women had received a mammogram and 80% received Pap tests. College education, high income, usual source of care, and health insurance consistently predicted use of preventive services. These factors also explained ethnic disparities in the receipt of preventive services between Latinas and white women. CONCLUSIONS: The results from our study are encouraging because only a minority of women do not receive age-appropriate preventive services. However, low socioeconomic status, lack of insurance, and lack of a usual source of care represent significant barriers to preventive care for adult women.

Adult↗

PubMed2003

Diagnosis and treatment of depression in the elderly medicare population: predictors, disparities, and trends.

OBJECTIVES: To develop nationally representative estimates of rates of diagnosis of depression; to determine rates and type of treatment received by those diagnosed with depression; and to ascertain socioeconomic differences and trends in treatment rates of depression, including the effect of supplemental insurance coverage, for elderly Medicare fee-for-service beneficiaries. DESIGN: Analysis of merged interview and Medicare claims data for multiple years from merged Medicare claims and interview data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare participants. SETTING: Community dwellers. PARTICIPANTS: Twenty thousand nine hundred sixty-six community-dwelling respondents aged 65 and older in the MCBS cost and use files for 1992 through 1998. MEASUREMENTS: Diagnoses recorded in Medicare claims were used to identify individuals who received a diagnosis of depression from a healthcare provider; pharmacy and claims data were used to identify receipt of antidepressants and psychotherapy by those diagnosed. RESULTS: The rate of depression diagnosis more than doubled, reaching 5.8% in 1998. Overall, about two-thirds of those diagnosed received treatment in each year; but those aged 75 and older, those of "Hispanic or other" ethnicity, and those without additional coverage to supplement Medicare were significantly less likely to receive treatment, controlling for other characteristics. If treated, members of these disadvantaged subgroups were less likely to receive psychotherapy. CONCLUSION: Although depression has been thought until recent years to be underrecognized in the elderly, rates of diagnosis increased dramatically in the 1990s, with concomitant increases in treatment. Nevertheless, significant disparities by age, ethnicity, and supplemental insurance coverage persist in treatment of those diagnosed. Because depression is a major source of potentially treatable morbidity in older people, increased efforts are needed to ensure access to appropriate treatment across all subgroups of older people and to remove economic barriers to treatment.

Activities of Daily Living↗

PubMed2003

Total and out-of-pocket expenditures for prescription drugs among older persons.

PURPOSE: The burden of prescription drug costs on Medicare beneficiaries has become a critical policy issue in improving the Medicare program, yet few studies have provided detailed and current information on that burden. The present study estimates total and out-of-pocket expenditures for prescription drugs and the burden of these costs in relation to income among the elderly population. We also compare spending and burden across major subgroups of the elderly population, as defined by socioeconomic and health characteristics, and we distinguish the impact of these factors by using multivariate models. DESIGN AND METHODS: The study uses nationally representative data on Medicare beneficiaries from the 1997 Medicare Current Beneficiary Survey Cost and Use files. The study estimates out-of-pocket prescription drug spending and burden through ordinary least square, median, and logistic regression models with corrections for the complex survey design. RESULTS: Our results show that in 1997, nearly 8% of the older population, more than 2.3 million people, spent greater than 10% of their income on prescription drugs. Despite pharmacy coverage, out-of-pocket cost burden fell most heavily on women and those with chronic health conditions. Burden was also higher among those with self-purchased supplemental coverage. IMPLICATIONS: The impact of Medicare reform proposals on these subgroups has to be carefully evaluated.

Age Distribution↗

PubMed2003

Diffusion of new generation antidepressant treatment among elderly diagnosed with depression.

RESEARCH OBJECTIVE: This study analyzes the prevalence of new generation antidepressant treatment including selective serotonin reuptake inhibitor (SSRI) use from 1992 to 1997 among the elderly diagnosed with depression, using a large, nationally representative survey of Medicare beneficiaries. Relationships between use of new generation antidepressant treatment and socioeconomic characteristics, physical comorbidity, insurance coverage, and care sector (mental health specialty vs. general health services) are explored. RESEARCH DESIGN: Merged survey data, Medicare claims, and detailed self-reports from the Medicare Current Beneficiary Survey were used to explore use of new generation antidepressant treatment.SUBJECTS Medicare beneficiaries aged 65 and older living in the community, enrolled in fee-for-service Medicare throughout the year and diagnosed with depression. RESULTS: In 1997, among an estimated 1.1 million community dwelling older adults with diagnosis of depression in health care claims, nearly two thirds received antidepressant treatments. Among those diagnosed with depression and treated with antidepressants, the use of new generation antidepressants increased from 35% in 1992 to 77% in 1997. The rates of use increased among all subgroups examined. In the early years after the introduction of these new antidepressant medications (1992-1994), there were socioeconomic disparities in use of these medications, with less use by less educated and poor patients. However, these differences abated over time. CONCLUSIONS: An increasing proportion of elderly treated for depression with antidepressants received the new generation antidepressants. The diffusion of these new medications lagged for those with low socioeconomic status defined by education and income. This diffusion process conforms to a general model of diffusion in which during the initial years following introduction of a new treatment, especially one which is costly, early adopters of the treatment are likely to disproportionately represent those of higher socioeconomic status.

Age Factors↗

PubMed2003

Ante- and postpartum substance abuse treatment and antiretroviral therapy among HIV-infected women on Medicaid.

OBJECTIVE: To examine temporal associations between obstetrics/gynecology (ob/gyn) care, substance abuse treatment (SAT), and antiretroviral therapy (ART) during and after pregnancy among HIV-infected women on Medicaid. METHOD: We identified 345 women, representing 378 deliveries, from merged New Jersey AIDS/HIV surveillance data and paid Medicaid claims data between 1992 and 1998. T-tests were used to analyze person-level differences in service use before and after delivery. Data were converted to person-months to predict SAT and receipt of ART in multivariate regressions that corrected for correlations among repeated observations. RESULTS: Compared to antepartum months there were significant reductions in ART and ob/gyn care in postpartum months and a significant increase in substance abuse. Multivariate analyses showed that compared to other months, women were more likely to obtain SAT during the postpartum period (odds ratio [OR] 1.51, 95% confidence interval [CI], 1.31-1.74); conversely, women were more likely to receive ART in the antepartum period (OR 1.77, 95% CI, 1.43-2.17). Ob/gyn care predicted ART and SAT, regardless of the timing of care relative to delivery. African American women were least likely to receive SAT and ART. CONCLUSION: Our findings underscore that ob/gyn providers have a central position in pathways to care for a vulnerable population of women with multiple health care needs and that patterns of ART use and SAT shift markedly during the months before and after delivery. However, receipt of ob/gyn care during these months is not associated with the changes, suggesting that ob/gyn providers may have untapped opportunities during the ante- and postpartum months to educate women with HIV/AIDS about the importance of consistent use of ART and to provide SAT referrals as needed. These results may have implications for policy makers interested in promoting adherence to ART and decreasing substance abuse among women with HIV/AIDS.

Adult↗