Post on 21-Jun-2020
Pathological gambling, co-occurring mental health and substance use disorders:
An Assessment of the Provision of Care by Clinician Specialty
Rosa Rodriguez-Monguio, PhD, MS
Maria Errea, PhD
Rachel Volberg, PhD
APHA Atlanta, GA. November 8, 2017
Presenter Disclosures
Authors declare that they have no competing interests
Outline
Background
Objectives
Data and Methods
Results
Conclusions
Background
Pathological gambling is an impulse control disorder concurrent with other psychiatric and substance use disorders
Little is known about treatment-seeking behaviors in patients with diagnosis of pathological gambling and co-occurring clinical disorders and associated treatment provision
Objectives
Assess socio-demographic characteristics of patients seeking treatment for pathological gambling and co-occurring substance use related addictions and mental health disorders
Analyze the workforce composition and geographic distribution of treatment providers
Estimate the likelihood of receiving care for psychiatric and substance use disorders by clinician specialty
Data
Massachusetts (MA) All-Payer Claims Database (APCD) for the period 2009-2013
Representative health claims database
Medical and pharmaceutical claims
All health care settings and levels of care
Physician/outpatient visits, inpatient and emergency department visits
Study Analytical Sample
Inclusion criteria
Commercially insured adult residents in Massachusetts who had a clinical diagnosis of pathological gambling (ICD-9-CM 31231) in any position any time in the study period and sought care in the Commonwealth
Exclusions: n = patients
Patients under 18 yrs.: n = 13
Patients (n= 8) providers (n= 2) zip code outside MA
Patients with public insurance only: n= 62
Patients whose first claim was in 2013: n=27
Methods
Analysis of the likelihood of receiving care for mental health and substance use disorders by clinician specialty Therapeutic providers: counseling psychologists, clinical social workers Prescribing providers: psychiatrists, general practice physicians
Univariate and multivariate logistic regression analysis controlling for age, gender, health insurance coverage and level of care - Adjusted Odds Ratios (AOR)
Multivariate logistic regression was conducted to estimate the likelihood of receiving care by assessed clinician specialties holding constant socio-demographic variables, type of health insurance coverage and level of care
Analyses performed with STATA MP 14 UMass Institution Review Board granted study approval
Patients Seeking Care in MA2009-2012
Diagnosis of PG in any position: 869 patients
71% males
27% aged 45-54 yrs.
25% Middlesex county
Private health insurance plans
47% Health Maintenance Organization (HMOs)
36% Preferred Provider Organization (PPOs)
13% Point of Service (POS)
Up to 4 co-occurring conditions 46% of patients
Patients with Diagnosis of PG Seeking Care in MA
407
492457 428
869
447
204229247204
373
185184193160
0
100
200
300
400
500
600
700
800
900
1,000
2009 2010 2011 2012 2009-2012
PG as Principal Diagnosis
PG as First Diagnosis
# Patients
PG in any Dx position
Most Prevalent Principal Diagnosis, 2009-2012
52%
30%
13%10%
6% 6%
0%
10%
20%
30%
40%
50%
60%
70%
Pathological
Gambling
Episodic
Mood
Disorders
Anxiety
Disorders
Psychoactive
Substances
Depressive
Disorders
Adjustment
Reaction
As a % of Patients with PG in Any Position N = 869
Psychoactive substances: Alcohol dependence syndrome (ICD9-code 303), drug dependence (ICD9-code 304) and non-dependent abuse of drugs (ICD9-code 305.0). Prevalence rates <3% were suppressed.
Most Prevalent Primary Diagnosis Pathological Gambling Principal
Diagnosis, 2009-2012
28%26%
18%
13%9%
0%
10%
20%
30%
40%
50%
Anxiety
Disorders
Episodic Mood
Disorders
Psychoactive
substances
Depressive
Disorders
Adjustment
Reaction
As a % of Patients with PG as Principal Dx N = 447
Psychoactive substances: Alcohol dependence syndrome (ICD9-code 303), drug dependence (ICD9-code 304) and non-dependent abuse of drugs (ICD9-code 305.0). Prevalence rates <3% were suppressed.
PG by MA County, 2009-2012
10%
7%
25%
14%
8%7%
10%12%
8%
13%11%11%
7%
23%
10%
8%
11%12%
12%
21%
5%
8%8% 8%
0%
10%
20%
30%
Bri
sto
l
Essex
Ham
pd
en
Mid
dle
sex
No
rfo
lk
Ply
mo
uth
Su
ffo
lk
Wo
rceste
r
Note: MA Counties ≤ 3% prevalence were suppressed
Patients Providers County Population
PG by Provider Specialty
PG as principal diagnosis significantly associated More than twofold likelihood of receiving care from
psychologists (AOR 2.8; p<0.01) and social workers (AOR 2.6; p<0.01)
Lower probability of receiving care from PCPs (AOR 0.40; p<0.01) and psychiatrists (AOR 0.37; p<0.01)
Depressive disorder diagnosis significantly associated with greater than three times likelihood of receiving care from PCPs (3.5; p<0.01).
PG by Provider Specialty
Having three diagnosis was significantly associated with a greater likelihood of receiving care from PCPs (AOR 2.9; p<0.01) and psychiatrists (AOR 4.7; p<0.01)
Having four or more diagnosis was significantly associated with a greater likelihood of receiving care from PCPs (AOR 5.6; p<0.001)
Limitations
Data through June 30, 2013
Right censored data
Pathological gamblers seeking care in MA
Underestimation of PG prevalence
Retrospective claims-based
Possible coding errors
Missing data for non-reimbursable variables
Conclusions
Anxiety disorders, mood disorders, and depressive disorders and psychoactive substance disorders are prevalent conditions in pathological gamblers
One in four treatment-seeking patients with a principal diagnosis of pathological gambling had a concurrent diagnosis of anxiety and mood disorders
One in five patients with a principal diagnosis of pathological gambling had a concurrent diagnosis of substance use disorders
Conclusions
Clinical complexity and prevalence of co-morbid psychiatric and substance use disorders among pathological gamblers seeking treatment
Unbalanced distribution and a shortage of mental health clinicians
Likelihood of receiving care by specialty clinicians significantly varied by comorbid disorder alone and as a bundle
Acknowledgements
Massachusetts Center for Health Information and Analysis (CHIA)
Funding provided by the Massachusetts Gaming Commission in Boston, MA
The findings, interpretations and conclusions expressed in this presentation are entirely those of the authors and do not represent the views of the Massachusetts Gaming Commission
Pathological gambling, co-occurring mental health and substance use disorders:
An Assessment of the Provision of Care by Clinician Specialty
Rosa Rodriguez-Monguio, PhD, MS
Maria Errea, PhD
Rachel Volberg, PhD
APHA Atlanta, GA. November 8, 2017