Dimoulas E, Blevins N, Frank R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1645.
Florida Center for Medicaid and the Uninsured, Clinical and Health Psychology, HSC Box 100165, Gainesville, FL 32610 Tel. 352.273.5130 Fax 352.273.5061
RESEARCH OBJECTIVE: Emergency department (ED) healthcare is expensive and episodic, yet a major component of healthcare services to low-income Americans (Shah-Canning et al, 1996). Multiple factors are associated with increased ED utilization, including lack of insurance, demographic and psychosocial factors, and poor access to a primary care provider (Padgett & Brodsky, 1992). Studies employing Medicaid samples find increased ED utilization as a function of available primary care services (de Alteriis & Fanning, 1991). Uncoordinated care occurs when the patient, independent of having a usual source of care, does not contact his or her primary care provider before utilizing care in the ED (Shah-Canning et al, 1996). PCCM (primary care case management) programs have been implemented to improve access to primary care providers, simultaneously increasing overall service use with a reduction in inappropriate utilization, such as ED use for non-emergency health events (Gill & Diamond, 1996). Anxiety disorders represent one such type of health problem that has a strong physiological component, often misinterpreted as life-threatening (e.g., heart racing in a panic attack can mimic non-psychological cardiac pain) and accompanied by a salient affective component (e.g., feeling anxious, worried, or hypervigilant of somatic symptoms) that may prompt immediate service utilization in the ED. Few studies have examined the patterns of ED utilization for individuals with anxiety disorders in a Medicaid PCCM. STUDY DESIGN: The Agency for Health Care Administration administers the Medicaid program in Florida and provided claims data as part of a contractual agreement with study investigators. Claims were available for adult enrollees (age 18-64) in MediPass, a PCCM program. The study consisted of a retrospective data analysis with a quasi-experimental design, which specified a 6-month pre and a 12-month post anxiety disorder diagnosis period of ED utilization. An 18-month study period spanned from December 2000-June 2002. ED utilization variables were constructed from outpatient facility claims. Visits were designated as pre or post and whether or not diagnosis at the emergency visit type was medical, psychological, or both. POPULATION STUDIED: Participants who received a diagnosis of any type of anxiety disorder from a primary care provider (i.e., family practice, general practice, internal medicine, or OB/GYN) in June 2001 but did not have a diagnosis in the prior 6 months. PRINCIPAL FINDINGS: 210 MediPass enrollees (173 women) met study criteria. The predominant anxiety disorder diagnosed was nonspecific (N=166 diagnosed with Anxiety, Not Otherwise Specified). Racial and ethnic composition of the sample (62% European American, 8.3% African American, 11.1% Latino American, and 18.5% Other) was consistent with the 2000 US Census demographics for Florida. Significant correlations were observed between utilization variables with the greatest association between post-diagnosis ED use associated with medical and psychological diagnoses (r = .499, p< .05). CONCLUSIONS: Differential patterns of ED use prior to and following anxiety diagnosis is suggestive of a moderating effect of psychological distress on increased utilization in the ED in this sample of Medicaid beneficiaries in a PCCM. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: If greater use of the ED occurs after misclassification of a health event as emergency then educational interventions should be targeted to patients and providers to reduce inappropriate utilization.
Publication Types:
Keywords:
- Adult
- African Americans
- Anxiety Disorders
- Case Management
- Delivery of Health Care
- European Continental Ancestry Group
- Female
- Florida
- Health Services
- Health Services Research
- Hospital Departments
- Humans
- Medicaid
- Panic Disorder
- Poverty
- Primary Health Care
- Psychiatric Status Rating Scales
- economics
- utilization
- hsrmtgs
UI: 103624679
From Meeting Abstracts