Dataset Information

The adoption of mental health drugs on state AIDS drug assistance program formularies.

ABSTRACT:

Objectives

We sought state-level factors associated with the adoption of medications to treat mental health conditions on state formularies for the AIDS Drug Assistance Program.

Methods

We interviewed 22 state and national program experts and identified 7 state-level factors: case burden, federal dollar-per-case Ryan White allocation size, political orientation, state wealth, passage of a mental health parity law, number of psychiatrists per population, and size of mental health budget. We then used survival analysis to test whether the factors were associated with faster adoption of psychotropic drugs from 1997 to 2008.

Results

The relative size of a state's federal Ryan White HIV/AIDS Program allocation, the state's political orientation, and its concentration of psychiatrists were significantly associated with time-to-adoption of psychotropic drugs on state AIDS Drug Assistance Program formularies.

Conclusions

Substantial heterogeneity exists across states in formulary adoption of drugs to treat mental illness. Understanding what factors contribute to variation in adoption is vital given the importance of treating mental health conditions as a component of comprehensive HIV care.

SUBMITTER: Martin EG

PROVIDER: S-EPMC3093265 | biostudies-literature | 2011 Jun

REPOSITORIES: biostudies-literature

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Publications

The adoption of mental health drugs on state AIDS drug assistance program formularies.

Martin Erika G EG Barry Colleen L CL

American journal of public health 20110414 6

<h4>Objectives</h4>We sought state-level factors associated with the adoption of medications to treat mental health conditions on state formularies for the AIDS Drug Assistance Program.<h4>Methods</h4>We interviewed 22 state and national program experts and identified 7 state-level factors: case burden, federal dollar-per-case Ryan White allocation size, political orientation, state wealth, passage of a mental health parity law, number of psychiatrists per population, and size of mental health b ...[more]

PMID: 21493949

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Project description:BackgroundIn the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.ObjectiveTo assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.DesignCross-sectional survey of 53 state and territorial ADAP formularies.Main measuresADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as "consistent" with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as "partially consistent". ADAPs without coverage were categorized as "no coverage".Key resultsOf 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).ConclusionsConsistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.

Project description:ImportanceFood insecurity is associated with an increased likelihood of poor mental health and suicidality. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the US; under broad-based categorical eligibility (BBCE), states have the option to expand SNAP eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility.ObjectivesTo examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults.Design, setting, and participantsThis ecological cross-sectional study used 2014 to 2017 data on US adults from the National Vital Statistics System and 2015 to 2019 data on US adults from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates. Analyses were conducted between September and November 2022.ExposuresState elimination of the asset test only and state adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) for 2014 to 2017 from the SNAP Policy Database.Main outcomes and measuresNumber of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide.ResultsAnalyses included 407 391 adult NSDUH participants and 173 085 adults who died by suicide. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% CI, 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults. State adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) was associated with decreased rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96). Results suggested a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared with states with neither policy, although this result was not statistically significant.Conclusions and relevanceState adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level.

Dataset Information

The adoption of mental health drugs on state AIDS drug assistance program formularies.

Objectives

Methods

Results

Conclusions

Publications

The adoption of mental health drugs on state AIDS drug assistance program formularies.

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