Patterns of mental health service use among Medicaid-insured youths treated by nurse practitioners and physicians: A retrospective cohort study.

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Date: Aug. 2021
Publisher: Elsevier B.V.
Document Type: Report
Length: 468 words

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Keywords Psychotropic medication; Psychosocial service; Nurse practitioner; Physician; Medicaid and children and adolescents Abstract Background Despite the growing involvement of nurse practitioners in mental health services for children and adolescents, little is known about the patterns of mental health service use among youths treated by nurse practitioners compared to those by physicians. Objectives To identify new users of psychotropic medications initiated by nurse practitioners and physicians among Medicaid-insured youths and to assess if receiving psychosocial services prior to or concurrent with medication initiation differs among youths treated by provider and specialty type. Design A retrospective cohort study. Settings We used Medicaid-insurance claims data in one mid-Atlantic state in the US. Participants A total 12,991 Medicaid-insured youths aged 0--20 years who started psychotropic medications prescribed by nurse practitioners or physicians with primary care or psychiatric specialty during 2013--2014. Methods Providers were grouped into nurse practitioners and physicians and into primary care and psychiatric specialty. Descriptive statistics were performed to compare each class of psychotropic medications initiated and psychiatric diagnoses of enrollees according to provider type within each specialty. Using multinomial logistic regression with psychiatrists as a reference group, we estimated the odds of having a type of prescriber for psychotropic medication initiation for youths who received psychosocial services prior to a new start of the medication and concurrently, compared to that for those who did not, after adjusting for patients' demographic characteristics and diagnosis. Results Youths served by nurse practitioners resided in small and non-metropolitan areas significantly more often than those served by their physician counterparts. There was no major difference in a class of psychotropic medications initiated by nurse practitioners and physicians within each specialty type, except a higher proportion of antidepressants (13.5% versus 10.5%) and a lower proportion of attention deficit hyperactivity disorder medications prescribed (68.8% versus 74.0%) by primary care nurse practitioners compared to their physician counterparts. Youths who received psychosocial services prior to medication initiation were less likely to have primary care physicians (Adjusted odds ratio=0.15, 95% confidence interval=0.82, 1.33) or primary care nurse practitioners (Adjusted odds ratio=0.16, 95% confidence interval=0.12, 0.20) as their initiating prescriber than those who did not. Conclusions Youths treated by nurse practitioners and physicians with or without psychiatric specialty showed unique patterns of mental health service use. Our findings can be used to build effective collaborations among provider and specialty type for quality of mental health services delivered to targeted populations in need. Author Affiliation: (a) Department of Health Sciences, Towson University, 8000 York Rd, Towson, MD 21252, USA (b) Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA * Corresponding author. Article History: Received 31 August 2020; Revised 15 April 2021; Accepted 17 April 2021 Byline: Bo Kyum Yang [byang@towson.edu] (a,*), Shannon Idzik (b), Paige Evans (a)

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Gale Document Number: GALE|A667643823