Dr. Quast is with the University of South Florida College of Public Health, Tampa. Dr. Gregory is with the Department of Politics and International Affairs, Northern Arizona University College of Social and Behavioral Sciences, Flagstaff. Dr. Storch is with the Department of Psychiatry, Baylor College of Medicine, Houston.
Psychiatr Serv. 2018 May 1;69(5):580-586. doi: 10.1176/appi.ps.201700281. Epub 2018 Jan 16.
This study examined changes in utilization of mental health services after Hurricane Katrina among children with preexisting conditions who were displaced from their homes in Louisiana disaster counties and resettled in Texas.
A retrospective analysis was performed on Medicaid claims data for 101,950 children from 2004 to 2006. Pre-post changes in utilization of mental health services by the displaced children and three control groups were compared. The control groups were children from Louisiana disaster counties who were not displaced, Louisiana children from nondisaster counties, and Texas children enrolled in Medicaid.
The proportion of children who had a prescription fill for psychotropic medication and the average days' supply per child decreased in each group, but the decreases were significantly larger for the displaced group than for the control groups. The decreases in both measures were largest for stimulants and antidepressants, the two most common medication classes. By contrast, changes in the proportion of children with an encounter involving psychiatric services and the average number of psychiatric services encounters per child did not vary systematically across the displaced and control groups.
The contrast between the results for medication utilization and encounters reveals a potential gap in post-Katrina provision of care. Although the findings for encounters indicate that, on average, displaced children did not experience a disruption in provider visits, the medication estimates suggest that they often did not obtain pharmaceutical treatment. Future disaster responses may be improved by addressing logistical impediments faced by disaster victims in filling their prescriptions for psychiatric medications.
本研究考察了路易斯安那州灾区因飓风卡特里娜而流离失所并在德克萨斯州重新安置的儿童，在搬离家园后，其精神健康服务利用情况的变化。
对 2004 年至 2006 年期间，来自路易斯安那州的 101950 名儿童的医疗补助索赔数据进行了回顾性分析。比较了流离失所儿童和三个对照组的精神健康服务利用情况的变化。对照组为未流离失所的路易斯安那州灾区儿童、来自非灾区的路易斯安那州儿童和参加医疗补助计划的德克萨斯州儿童。
服用精神类药物的儿童比例和每名儿童的平均供应天数均在各组中下降，但流离失所组的降幅明显大于对照组。在两种药物中，降幅最大的是兴奋剂和抗抑郁药，这两种是最常见的药物类别。相比之下，涉及精神科服务的儿童比例和每名儿童的平均精神科服务次数的变化在流离失所组和对照组之间并没有系统地变化。
药物使用和就诊情况的结果差异揭示了卡特里娜飓风后护理提供方面的潜在差距。尽管就诊情况的发现表明，流离失所的儿童平均而言没有中断就诊，但药物使用情况表明，他们往往没有获得药物治疗。未来的灾难应对措施可能会通过解决灾难受害者在填写精神科药物处方时面临的后勤障碍而得到改善。
