Unmet mental health need and subsequent substance use in individuals with a history of depression: Are there differences between metro and nonmetro areas?

BACKGROUND AND OBJECTIVES: More than nine million U.S. adults have a co-occurring mental health and substance use disorder. The self-medication hypothesis suggests that individuals with unmet need may alleviate the symptoms of their mental illness by using alcohol or drugs. We examine the relationship between unmet mental health need and subsequent substance use among individuals with a history of depression as well as differences in metro and nonmetro areas. METHODS: We used repeated cross-sectional data from the National Survey on Drug Use and Health (NSDUH), 2015-2018 after identifying individuals with depression in the past year (n = 12,211). We used logistic regressions with interaction terms to examine the association between unmet need for mental health care and substance use by geographic location. RESULTS: Unmet mental health need was associated with increased use of marijuana (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.08-1.64), illicit drugs (OR = 1.75, 95% CI: 1.19-2.58), and prescription drugs (OR = 1.89, 95% CI: 1.19-3.00) among individuals with depression, which did not vary by geographic location. Unmet need was not associated with increased heavy alcohol drinking (OR = 0.87, 95% CI: 0.60-1.26). DISCUSSION AND CONCLUSIONS: No differences in substance usage between metro and nonmetro populations were observed for those with an unmet need for mental health care. We found support for the self-medication hypothesis among individuals with depression with respect to alcohol. SCIENTIFIC SIGNIFICANCE: We examine whether individuals with depression and unmet care needs are more likely to self-medicate with substances including prescription drugs. Due to higher unmeet needs in nonmetro areas, we examine whether the likelihood of self-medication differs in metro and nonmetro areas.

Measuring rurality in health services research: a scoping review.

PURPOSE: This study is a scoping review of the different methods used to measure rurality in the health services research (HSR) literature. METHODS: We identified peer-reviewed empirical studies from 2010-2020 from seven leading HSR journals, including the Journal of Rural Health, that used any definition to measure rurality as a part of their analysis. From each study, we identified the geographic unit (e.g., county, zip code) and definition (e.g., Rural Urban Continuum Codes, Rural Urban Commuting Areas) used to classify categories of rurality. We analyzed whether geographic units and definitions used to classify rurality differed by focus area of studies, including costs, quality, and access to care. Lastly, we examined the number of rural categories used by authors to assess rural areas. FINDINGS: In 103 included studies, five different geographic units and 11 definitions were used to measure rurality. The most common geographic units used to measure rurality were county (n = 59, 57%), which was used most frequently in studies examining cost (n = 12, 75%) and access (n = 33, 57.9%). Rural Urban Commuting Area codes were the most common definition used to measure rurality for studies examining access (n = 13, 22.8%) and quality (n = 10, 44%). The majority of included studies made rural versus urban comparisons (n = 82, 80%) as opposed to focusing on rural populations only (n = 21, 20%). Among studies that compared rural and urban populations, most studies used only one category to identify rural locations (n = 49 of 82 studies, 60%). CONCLUSION: Geographic units and definitions to determine rurality were used inconsistently within and across studies with an HSR focus. This finding may affect how health disparities by rural location are determined and thus how resources and federal funds are allocated. Future research should focus on developing a standardized system to determine under what circumstances researchers should use different geographic units and methods to determine rurality by HSR focus area.

Inpatient opioid receipt and care experiences for vaginal delivery.

OBJECTIVES: To examine the relationship between care experiences and inpatient opioid receipt during and after delivery for women hospitalized for vaginal delivery (VD). STUDY DESIGN: We used a pooled cross-sectional design with inverse probability weighting to examine the association between inpatient opioid receipt and care experiences of women hospitalized for VD at a single health care system in a Midwestern state. We used 4 Hospital Consumer Assessment of Healthcare Providers and Systems scores (2 pain care items and 2 global items) as measures of care experiences of women hospitalized for VD. METHODS: We used 4 inverse probability-weighted logit regressions to estimate the relationship between inpatient opioid receipt and each patient care experience measure. In supplementary analyses, we used the same inverse probability-weighted methods to estimate the relationship between receipt of opioids and patient care experience measures in 3 patient subgroups based on mean patient-reported pain score during hospitalization (no pain, mild pain, moderate pain). RESULTS: We found no relationship between inpatient opioid receipt and inpatient pain care experiences. As an exception, we found that women hospitalized for VD were 5 (95% CI, 2-8) percentage points more likely to rate the hospital as 10 ("the best hospital possible") during hospitalizations in which an opioid was received. We also found higher overall ratings of the hospital among hospitalized women who reported mild pain if they received an opioid (marginal effects = 0.05; 95% CI, 2-8 percentage points). CONCLUSIONS: Receipt of opioids may not be a significant determinant of the pain-specific patient care experiences of women hospitalized for VD.

Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions.

BACKGROUND: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. OBJECTIVE: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. METHODS: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. RESULTS: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. CONCLUSIONS: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.

Perceptions of Nutrition Education in the Current Medical School Curriculum.

BACKGROUND AND OBJECTIVES: Although the National Academy of Sciences has recommended a minimum of 25 hours of nutrition education, the majority of medical schools offer very little to no training or education in nutrition to medical students during their tenure in medical school. In order to assess the relevance and efficacy of current levels of nutrition training as viewed by students, residents, and physicians, as well as possible areas for further improvement, the authors conducted a qualitative study exploring students' experiences. METHODS: Medical students, residents, and physicians at a Midwestern medical school were interviewed during a series of eight focus groups and one-on-one interviews. Results were coded and analyzed using NVivo qualitative software for emerging themes. RESULTS: Medical students felt nutrition was poorly integrated into the curriculum. They witnessed little nutrition counseling during shadowing experiences, and the nutrition information that was imparted was often outdated or incorrect. Residents stated they felt ill-prepared to offer nutrition counseling and desired further education in this area. CONCLUSIONS: Overall, medical students and physicians agreed that the nutrition education currently provided in medical school is inadequate. Residents stated they would benefit from further training in behavioral counseling in order to increase their confidence in educating patients about nutrition. Increasing training in these areas could translate into improved health outcomes.

Encouraging smoking cessation during pregnancy in West Virginia: using Fax-to-Quit as a cessation strategy.

Despite known dangers of smoking, a majority of pregnant women continue to smoke or relapse following delivery. West Virginia women have high unmet needs for smoking cessation, and the prenatal period presents a critical and unique opportunity for education and quitting assistance. West Virginia's Fax-to-Quit program uses provider-faxed referrals to the Quitline to engage smokers and connect them with cessation services. A 12-month feasibility evaluation of this Fax-to-Quit program for pregnant women was conducted. In February 2009, providers and staff from three OB/GYN clinics in three adjoining West Virginia counties were recruited. All participating sites received an intensive half-day training program. Adult pregnant smokers receiving prenatal care in these OB/GYN clinic sites were eligible to participate. Recruitment sites screened pregnant women for smoking; assessed readiness-to-quit; and enrolled consenting participants in the Fax-to-Quit Program. The Quitline measured cessation attempts with six-month follow-up of enrolled participants. Between March-December 2009, 58 referrals were made at these OB/GYN clinic sites, with 15 women (25.9%) enrolling in Quitline services. These enrolled women account for approximately one-quarter of calls from pregnant smokers to the West Virginia Quitline in the past 12 months. Contact, communication, and cooperation with office staff were relevant and important to successful project implementation. Findings indicate that Fax-to-Quit is feasible to engage providers and pregnant smokers with the West Virginia Quitline. Successful referrals and enrollment demonstrate Fax-to-Quit may support cessation by increasing Quitline use and connecting pregnant women who smoke with quitting services through provider-faxed referrals to the West Virginia Quitline.