Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of America.
J Subst Abuse Treat. 2019 Apr;99:9-15. doi: 10.1016/j.jsat.2019.01.010. Epub 2019 Jan 11.
Adults released from incarceration are at high risk of death from drug-related causes, pointing to the importance of connecting individuals to healthcare services after release from prison. Though Medicaid plays an important role in financing behavioral health treatments for vulnerable groups, many states terminate individuals' Medicaid coverage during incarceration. A significant risk factor for substance use disorders (SUD) among incarcerated individuals is serious mental illness (SMI). In January 2006, Washington State began a program of expedited Medicaid enrollment for individuals with mental illnesses being discharged from state prisons, jails, and psychiatric hospitals. Prior literature has shown this program to be effective in increasing Medicaid enrollment and use of mental health services for people with SMI. The current paper examined the effect of referral to expedited Medicaid on use of SUD treatment for people with SMI released from prison. Our sample consisted of 3086 individuals with a diagnosis of SMI who were released from prison from January 1, 2006 to December 31, 2007. Of the sample we identified, 871 individuals received referrals for expedited Medicaid and 2215 did not. To control for selection bias on observed characteristics for referral, we used inverse probability weights (IPW) to balance the referred and not-referred groups on more than 50 baseline covariates. We used doubly-robust IPW models to estimate the effect of referral to expedited Medicaid on use of SUD treatments following prison release. Approximately 12% of our sample used any SUD treatment by 3 months after release, with this percentage rising to 28% at 12 months. When controlling for baseline differences, referral to expedited Medicaid enrollment was associated on average with a 6.7 (SE 2.9, p < .05) percentage point increase in the predicted probability of using any SUD treatment in the 3 months following release as compared to those not referred to the program. This effect size represents a 61% increase in the probability of using any treatment by 3 months. The result was similar for the 6-month follow-up period and persisted at the 12-month follow-up though the magnitude of the effect decreased somewhat. Overall, our results suggest that expedited Medicaid enrollment for people with SMI released from prison can increase use of SUD services.
从监禁中获释的成年人因与药物相关的原因而死亡的风险很高，这表明在从监狱获释后将个人与医疗保健服务联系起来的重要性。尽管医疗补助在为弱势群体提供行为健康治疗方面发挥着重要作用，但许多州在监禁期间终止个人的医疗补助覆盖范围。监禁中的个人物质使用障碍（SUD）的一个重要危险因素是严重的精神疾病（SMI）。2006 年 1 月，华盛顿州开始为从州监狱、监狱和精神病院出院的精神疾病患者提供快速医疗补助入籍计划。先前的文献表明，该计划在增加 SMI 患者的医疗补助入籍和使用精神卫生服务方面是有效的。当前的论文研究了为 SMI 患者提供快速医疗补助入籍对从监狱获释后 SUD 治疗使用的影响。我们的样本由 3086 名被诊断患有 SMI 并于 2006 年 1 月 1 日至 2007 年 12 月 31 日期间从监狱获释的个人组成。在我们确定的样本中，有 871 人接受了快速医疗补助入籍的转介，而 2215 人没有。为了控制观察特征对转介的选择偏差，我们使用逆概率权重（IPW）在 50 多个基线协变量上平衡转介和未转介组。我们使用双重稳健 IPW 模型来估计向快速医疗补助转介对监狱释放后 SUD 治疗使用的影响。我们样本中的约 12%在释放后 3 个月内使用了任何 SUD 治疗，在 12 个月时这一比例上升至 28%。在控制基线差异的情况下，与未被转介到该计划的人相比，向快速医疗补助入籍的转介平均与预测的在释放后 3 个月内使用任何 SUD 治疗的概率增加了 6.7（SE 2.9，p<.05）个百分点。这个效果大小代表在 3 个月内使用任何治疗的概率增加了 61%。在 6 个月的随访期内，结果相似，并且在 12 个月的随访期内仍然存在，尽管效果的幅度有所下降。总体而言，我们的结果表明，为从监狱获释的 SMI 患者提供快速医疗补助入籍可以增加 SUD 服务的使用。
