Biomedical subjects

Wenhui Wei

Publications and source records attributed to Wenhui Wei.

6 recordsLinked to original sources

PubMed2006

Diabetes and depression care among medicaid beneficiaries.

This study evaluates the relationship between diabetes mellitus and depression care among non-elderly Medicaid beneficiaries, using claims data from the 1995 State Medicaid Research Files for Alabama, Georgia, New Jersey, and Wisconsin. Presence of comorbid diabetes was found to be significantly associated with a higher rate of depression diagnosis. Among those who were diagnosed as depressed, treatment of comorbid diabetes was associated with a higher rate of antidepressant treatment than among depression-diagnosed patients who did not also have diabetes. However, among patients with diabetes and depression, a quarter received only tricyclic antidepressants. Controlling for other characteristics, African Americans diagnosed with depression were less likely to receive antidepressant treatment and, if they did receive such treatment, more likely to receive the older tricyclic drugs. These findings raise concern for glycemic control among patients with diabetes and depression treated with tricyclic antidepressants in a low-income Medicaid population. Among depressed Medicaid beneficiaries with diabetes, there are racial differences with regard to quality of mental health care in the presence of diabetes.

Adolescent↗

PubMed2005

Mental illness, traumatic brain injury, and medicaid expenditures.

OBJECTIVE: To estimate the rates of mental illness among Medicaid beneficiaries with traumatic brain injury (TBI) and associated Medicaid-paid expenditures. DESIGN: Retrospective claims-based calendar year data. SETTING: Claims data. PARTICIPANTS: Medicaid recipients with diagnosed TBI and mental illness who received Medicaid services in 4 states in 1995. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Annual expenditures for total, inpatient, and noninpatient services, as derived from Medicaid personal summary files. Mental illness and TBI were identified by using International Classification of Diseases, 9th Revision , Clinical Modification codes recorded in Medicaid claims. RESULTS: Of a total of 493,663 Medicaid recipients, 3641 (0.7%) were diagnosed with TBI in the 4 states. Significant demographic and racial differences were found in the rates of TBI; 18% of patients with TBI were diagnosed with serious mental illness. People with TBI in the age group 40 to 49 years were more likely to have a mental disorder. There were significant differences in estimated total, inpatient, and noninpatient expenditures between those with and without mental illness. In general, those with serious mental illness had higher Medicaid-paid expenditures than those without any mental illness. CONCLUSIONS: Psychiatric comorbidity in TBI increases the overall expenditures in this population. This increased cost is an important consideration in programming for those with TBI.

Adult↗

PubMed2005

Use of psychotherapy for depression in older adults.

OBJECTIVE: The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment. METHOD: Linked Medicare claims and survey data from the 1992-1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency. RESULTS: The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients' socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy. CONCLUSIONS: Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults.

Age Factors↗

PubMed2004

Sensitivity of an AIDS case-finding algorithm: who are we missing?

OBJECTIVE: The objective of this study was to determine the sensitivity of an AIDS case-finding algorithm. METHOD: This study applied the AIDS case-finding algorithm to paid Medicaid claims linked to New Jersey AIDS surveillance data and assesses its sensitivity across subgroups of patients. FINDINGS: Of the 7183 cases with confirmed AIDS, based on the state's registry information, 95% (n = 6818) were correctly detected using all Medicaid claims, including pharmacy. For patients in a community-based waiver program, covered by Medicare, diagnosed with a severe mental illness, or continuously enrolled in Medicaid, with regular contact with the medical system, the algorithm identified almost all patients. To further evaluate algorithm performance, it was used with 2 groups of interest to researchers. For AIDS patients in the last 6 months of life, 88% were correctly detected without use of pharmacy claims and 95% when pharmacy claims were included. For pregnant women, data from the 6 months before the latest delivery date identify 27% of pregnant women without pharmacy claims and 41% when pharmacy claims were included. Using claims made after the latest delivery date, 81% of pregnant women were detected without pharmacy claims and 93% when pharmacy claims were included CONCLUSION: Results demonstrate that a multilevel screen can be used with Medicaid claims to effectively to detect most patients with AIDS. Detection is lower for some subgroups, and the absence of pharmacy claims can compromise detection.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Ante- and postpartum substance abuse treatment and antiretroviral therapy among HIV-infected women on Medicaid.

OBJECTIVE: To examine temporal associations between obstetrics/gynecology (ob/gyn) care, substance abuse treatment (SAT), and antiretroviral therapy (ART) during and after pregnancy among HIV-infected women on Medicaid. METHOD: We identified 345 women, representing 378 deliveries, from merged New Jersey AIDS/HIV surveillance data and paid Medicaid claims data between 1992 and 1998. T-tests were used to analyze person-level differences in service use before and after delivery. Data were converted to person-months to predict SAT and receipt of ART in multivariate regressions that corrected for correlations among repeated observations. RESULTS: Compared to antepartum months there were significant reductions in ART and ob/gyn care in postpartum months and a significant increase in substance abuse. Multivariate analyses showed that compared to other months, women were more likely to obtain SAT during the postpartum period (odds ratio [OR] 1.51, 95% confidence interval [CI], 1.31-1.74); conversely, women were more likely to receive ART in the antepartum period (OR 1.77, 95% CI, 1.43-2.17). Ob/gyn care predicted ART and SAT, regardless of the timing of care relative to delivery. African American women were least likely to receive SAT and ART. CONCLUSION: Our findings underscore that ob/gyn providers have a central position in pathways to care for a vulnerable population of women with multiple health care needs and that patterns of ART use and SAT shift markedly during the months before and after delivery. However, receipt of ob/gyn care during these months is not associated with the changes, suggesting that ob/gyn providers may have untapped opportunities during the ante- and postpartum months to educate women with HIV/AIDS about the importance of consistent use of ART and to provide SAT referrals as needed. These results may have implications for policy makers interested in promoting adherence to ART and decreasing substance abuse among women with HIV/AIDS.

Adult↗

PubMedDate not supplied

Disability and receipt of clinical preventive services among women.

BACKGROUND: More individuals are surviving catastrophic injuries and living longer with persistent disability; however, their receipt of clinical preventive services is not well understood as compared with those without disabilities given the dual focus of care on both primary prevention and the prevention of secondary complications related to their disabilities. METHODS: Longitudinal analyses of 1999-2002 Medical Expenditure Survey (MEPS). Study sample consisted of 3,183 community-dwelling women aged 51-64 years and followed for 2 full years. Women with disabilities were defined as having reported any limitation in any area of activity of daily living in 2 years. Recommended clinical preventive services were defined as receiving the following at the recommended intervals: colorectal, cervical, and breast cancer; cholesterol screening; and influenza immunization. chi(2) tests and multiple logistic regressions were used to examine variations in use of clinical preventive services. RESULTS: Overall, 23% of the women in the study (n = 835) were disabled. Disabled women, however, were less likely to receive mammography and Pap smears within the recommended intervals. However, disabled women were more likely to receive influenza immunization, cholesterol screening, and colorectal screening within the recommended intervals. Among the disabled, usual source of care and health insurance remained significant predictors of receipt of clinical preventive services across all types, CONCLUSIONS: Disabled women were less likely to receive some of the cancer screening services, suggesting a need for targeted interventions to promote breast cancer and cervical cancer screening. Increased access to health care insurance and health care providers may also help.

Breast Neoplasms↗