Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2024 Apr 1;7(4):e248519. doi: 10.1001/jamanetworkopen.2024.8519.
To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services.
To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023.
Receipt of care at a practice participating in CPC+.
Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone.
The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter).
Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.
为了满足对心理健康和物质使用服务日益增长的需求，医疗保险和医疗补助服务中心于 2017 年启动了为期 5 年的综合初级保健加（CPC+）试点，要求初级保健实践整合行为健康服务。
在 COVID-19 大流行前后，调查 CPC+与获得心理健康和物质使用治疗的关联。
设计、地点和参与者：本回顾性队列研究使用差异中的差异分析，将 2018 年 1 月 1 日至 2022 年 6 月 30 日期间归因于 CPC+和非 CPC+实践的成年人进行比较。该研究包括年龄在 19 至 64 岁之间、患有抑郁症、焦虑症或阿片类药物使用障碍（OUD）且在宾夕法尼亚州参加私人健康保险的成年人。数据于 2023 年 1 月至 6 月进行分析。
在参与 CPC+的实践中接受护理。
总护理成本和用于评估和管理的初级保健就诊次数、社区心理健康中心就诊次数、精神病院就诊次数、物质使用治疗就诊次数（住院和非住院）以及用于治疗抑郁症、焦虑症、丁丙诺啡、纳曲酮或美沙酮的处方数量。
样本中的 188770 名个体包括 102733 名成年人（平均[SD]年龄，49.5[5.6]岁；57531 名女性[56.4%]）归因于 152 个 CPC+实践和 86037 名成年人（平均[SD]年龄，51.6[6.6]岁；47321 名女性[54.9%]）归因于 317 个非 CPC+实践。在诊断为 OUD 的患者中，与归因于非 CPC+实践的患者相比，归因于 CPC+实践与开出更多丁丙诺啡（每季度每位患者 0.117[95%CI，0.037 至 0.196]处方）和阿普唑仑（每季度每位患者 0.162[95%CI，0.005 至 0.319]处方）的处方有关。在诊断为抑郁症或焦虑症的患者中，归因于 CPC+实践与开出更多丁丙诺啡（每季度每位患者 0.024[95%CI，0.006 至 0.041]处方）有关。
这项队列研究的结果表明，与接受非 CPC+实践护理的患者相比，患有 OUD 并在 CPC+实践中接受护理的个体开出了更多的丁丙诺啡和阿普唑仑处方。随着医疗保险和医疗补助创新中心投资于先进的初级保健示范项目，了解这些模式是否与高质量初级保健的指标相关至关重要。
