THE EFFECT OF MENTAL HEALTH SPECIALIST USE ON HEALTHCARE UTILIZATION OF ADULTS WITH CO-OCCURRING DIABETES AND DEPRESSION Public Deposited

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  • March 21, 2019
Creator
  • Lin, Ching-Ching
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • The population of individuals with multiple chronic conditions is growing and is estimated to have the highest healthcare utilization among other subgroups. Diabetes and major depressive disorder are two of the most common chronic conditions co-occurring among the multiple chronic conditions population. Like other individuals with multiple chronic conditions, those with co-occurring diabetes and major depressive disorder tend to incur higher healthcare utilization but lower rates of guideline-concordant care, compared to patients with either condition only. Primary care physicians and mental health specialists are two major provider types that provide depression care. While the shortage of mental health specialist supply keeps the rate of mental health specialist use low, primary care physicians have become more engaged in providing depression care, as the treatment modality shifts increasingly towards more pharmacotherapy. Some research has demonstrated that mental health specialist care leads to higher level of guideline-concordant depression care than primary care in individuals with depression. Yet evidence of the impact of mental health specialist care on guideline-concordant care in individuals with co-occurring diabetes and major depressive disorder has not yet been determined. As individuals with diabetes and major depressive disorder are mainly managed at primary care, examining the role of the mental health specialist among this population is critical. Using an economics theoretical framework, the objective of this study is to examine whether mental health specialist use affects guideline-concordant care and emergency department/hospitalization care among adult Medicaid beneficiaries with co-occurring diabetes and major depressive disorder. First, with mental health specialist supply as instrumental variables and person-level fixed effect specification, this study examined the effect of mental health specialist care on primary care visit as well as guideline-concordant care for both major depressive disorder and diabetes in the study population. Second, this study investigated the effect of mental health specialist care on emergency department and hospitalization care utilization with instrumental variables and General Estimating Equations method. Results from this study show that mental health specialist care increases likelihood of receiving guideline-concordant depression care. It also increases probabilities of visiting a primary care provider and receiving annual eye exam, but decreases adherence level of receiving annual lipid test and A1c tests. Finally, mental health specialist care is found to reduce both overall number of all-cause emergency department visits and likelihood of all-cause hospitalizations. Findings from this dissertation suggest that individuals with co-occurring diabetes and major depressive disorder will benefits from mental health specialist care as quality of depression care improves and tertiary care utilization reduces. Nevertheless, the negative effect of mental health specialist care on some guideline-concordant diabetes care also implies that, for individuals with multiple chronic conditions, any policy aiming to improve mental health care delivery also needs to address the spillover effect of mental health care on other co-occurring conditions. Several areas for future research exist that can advance our understanding of mental health specialist care in order to inform future policy decisions regarding programs aimed at improving mental health care for people with multiple chronic conditions.
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  • In Copyright
Advisor
  • Sloan, Frank
  • Gaynes, Bradley
  • Holmes, George M.
  • Domino, Marisa
  • Weinberger, Morris
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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