Another IBH-PC Publication: Case control study of access to medications during COVID-19 and longitudinal impact on health outcomes for primary care patients managing multiple chronic conditions

 

Another IBH-PC publication: Gail L Rose, Levi N Bonnell, Lisa W Natkin, Jennifer O’Rourke-Lavoie, Constance van Eeghen, Case control study of access to medications during COVID-19 and longitudinal impact on health outcomes for primary care patients managing multiple chronic conditions, Family Practice, 2024;, cmae074, https://doi.org/10.1093/fampra/cmae074 Abstract Background During coronavirus disease 2019 (COVID-19), people managing multiple chronic conditions (MCCs) experienced barriers to obtaining needed medications. The purposes of this paper are to (i) determine risk factors for difficulty obtaining medications during COVID-19, (ii) document reasons for the difficulty, and (iii) evaluate the impact on later physical and mental health outcomes. Method In a randomized controlled trial conducted in 2016–2021, 1969 adult primary care patients were surveyed about physical and mental health both before and during COVID-19. They reported their needs for medication during COVID-19 and any difficulty obtaining them. Reasons for difficulty accessing medications were tabulated descriptively. Logistic regression identified predictors of medication access difficulty. Multivariable linear regression modeled the relationship between access to medications and health outcomes, accounting for pre-COVID health. Results  In total 13% of participants experienced difficulty accessing needed medications. Compared to the larger sample, those participants were younger, had more MCCs, and had lower income. They were more often female, unmarried, and were facing insecurities in housing, food, or finances (all P < 0.004). Younger age and the presence of socioeconomic insecurity at baseline increased the odds of later difficulty accessing medications. Barriers to access included concerns about contracting COVID-19 (52%), physician or pharmacy inaccessibility (38%), and cost (26%). Adjusting for baseline health, difficulty accessing medications was associated with poorer health at follow up (P = 0.001). Conclusion   People with socioeconomic disadvantages experienced a disproportionate impact of difficulty obtaining medications and poorer health outcomes due to COVID-19. They may be at greater risk in the event of future pandemics and other societal disruptions.   Keywords: access to medications, COVID-19, health status, mental health, multiple chronic conditions, primary health care   Issue Section: HEALTH SERVICE RESEARCH

Associations of intervention stage completion on practice level of integrated behavioral health and behavioral health outcomes

 

Congratulations to Kari Stephens and her co-authors on the latest paper from IBH-PC:

Stephens, K. A., van Eeghen, C., Zheng, Z., Anastas, T., Ma, K. P. K., Prado, M. G., Clifton, J., Rose, G., Mullin, D., Chan, K. C. G., & Kessler, R. (in press). Associations of intervention stage completion on practice level of integrated behavioral health and behavioral health outcomes in an integrated behavioral health and primary care randomized pragmatic intervention trial. Annals of Family Medicine. PMCID: in progress.

Purpose 

A pragmatic, cluster-randomized controlled trial of a comprehensive practice-level, multi-staged practice transformation intervention aimed to increase behavioral health integration in primary care practices and improve patient outcomes. We examined association between completion of intervention stages and patient outcomes across a heterogenous national sample of primary care practices. 

Methods 

Forty-two primary care practices across the U.S. with co-located behavioral health and 2,945 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint and two year follow-up. Effects of intervention on patient health and primary care integration outcomes were examined using multilevel mixed-effects models, controlling for baseline outcome measurements.  

Results 

No differences were found associated with the number of intervention stages completed and patient health outcomes, including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social participation and physical function. The completion of each intervention stage was associated with increases in Practice Integration Profile (PIP) domain scores and were  confirmed with modeling using multiple imputation for: Workflow 3.5 (95% CI: 0.9-6.1), Integration Methods 4.6 (95% CI: 1.5-7.6), Patient Identification 2.9 (95% CI: 0.9-5.0), and Total Integration 2.7 (95% CI: 0.7-4.7). 

Conclusion 

A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogenous primary care practices treating patients with multiple chronic conditions​ when accounting for completion of intervention stages​. Interventions that allow practices to flexibly improve care have potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at a population level.

Letter to the editor- Financial Times - Broadening awareness of IBH

Attached is a copy of a letter to the editor of the Financial Times, Aug 30 2024, page 14, broadening awareness of IBH and its value.

FT has global readership of over 1 million, digital and print. Talk about message 'reach' !!