Evidence map›Paper›PMID 30366189›Full record

ArticleDrug and alcohol dependence2018

Characteristics of patients with substance use disorder before and after the Affordable Care Act.

Cynthia I Campbell, Sujaya Parthasarathy, Andrea Altschuler, Kelly C Young-Wolff, Derek D Satre

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Drug and alcohol dependence, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Cynthia I CampbellDivision of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA. Electronic address: cynthia.i.campbell@kp.org.
Sujaya ParthasarathyDivision of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA.
Andrea AltschulerDivision of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA.
Kelly C Young-WolffDivision of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA.
Derek D SatreDivision of Research, Kaiser Permanente Northern California Region, 2000 Broadway, 3rdFloor, Oakland, CA, 94612, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, USA.

Funding

The Impact of Health Care Reform on Addiction and HIV ServicesR33DA035645 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CAMPBELL, CYNTHIA I, SATRE, DEREK D · 2014 to 2017
$1.8M
The Impact of Health Care Reform on Addiction and HIV ServicesR21DA035645 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CAMPBELL, CYNTHIA I, SATRE, DEREK D · 2013 to 2013
$238k
NIDA NIH HHS R21 DA035645NIDA NIH HHS R33 DA035645
6 · The paper itself

Abstract

backgroundThe Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of newly enrolled patients with SUD in a large healthcare delivery system differed pre- and post- ACA implementation.

methodsIn this mixed-methods study, qualitative interviews were conducted with health system leaders to identify themes regarding how the health system prepared for the ACA. Electronic health record data were used to examine demographics, as well as specific SUD, psychiatric, and medical diagnoses in cohorts of pre-ACA (2012, n = 6066) vs. post-ACA (2014, n = 7099) newly enrolled patients with SUD. Descriptive statistics and logistic regression models were employed to compare pre-ACA and post-ACA measures.

resultsInterviewees felt much uncertainty, but anticipated having to care for more SUD patients, who might have greater severity. Quantitative findings affirmed these expectations, with post-ACA SUD patients having higher rates of cannabis and amphetamine use disorders, and more psychiatric and medical conditions, compared to their pre-ACA counterparts. The post-ACA SUD cohort also had more Medicaid patients and greater enrollment in high-deductible plans.

conclusionsPost-ACA, SUD patients had more comorbidities as well as and more financial barriers to care. As federal healthcare policy continues to evolve, with potentially more restrictive coverage criteria, it is essential to continue examining how health systems adapt to changing health policy and its impact on SUD care.

Indexed as

Delivery of Health CareHealth PolicyInsurance CoveragePatient Protection and Affordable Care ActAdultElectronic Health RecordsFemaleHumansMaleMedicaidMiddle AgedSubstance-Related DisordersUnited StatesAffordable Care ActElectronic health recordHealth InsuranceMixed methodsSubstance use disorder

Identifiers

PMID30366189
PMCPMC6703160

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.