Profiting and providing less care

Comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND:: Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. OBJECTIVE:: To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. DESIGN, SETTING, AND PARTICIPANTS:: Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). MAIN OUTCOME MEASURE:: Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. RESULTS:: Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). CONCLUSIONS:: For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

Original languageEnglish (US)
Pages (from-to)428-434
Number of pages7
JournalMedical Care
Volume52
Issue number5
DOIs
StatePublished - 2014

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Opioid Analgesics
Odds Ratio
Confidence Intervals
Psychiatry
Social Work
Communicable Diseases
Therapeutics
Logistic Models
Government Regulation
Social Problems
Medicaid
Health Insurance
Ambulatory Care
Sexually Transmitted Diseases
Hepatitis
HIV Infections
Comorbidity
Cross-Sectional Studies
Outcome Assessment (Health Care)
HIV

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

@article{533b635edd3145d2b09538821fd6e415,
title = "Profiting and providing less care: Comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States",
abstract = "BACKGROUND:: Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. OBJECTIVE:: To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. DESIGN, SETTING, AND PARTICIPANTS:: Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). MAIN OUTCOME MEASURE:: Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. RESULTS:: Of opioid treatment programs, 58.0{\%} were for profit, 33.5{\%} were nonprofit, and 8.5{\%} were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95{\%} confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95{\%} CI, 4.9, 13.1), and social services support (AOR, 3.3; 95{\%} CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95{\%} CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95{\%} CI, 12.6, 52.5), and social services support (AOR, 2.4; 95{\%} CI, 1.4, 4.3). CONCLUSIONS:: For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.",
author = "Bachhuber, {Marcus A.} and Southern, {William N.} and Cunningham, {Chinazo O.}",
year = "2014",
doi = "10.1097/MLR.0000000000000121",
language = "English (US)",
volume = "52",
pages = "428--434",
journal = "Medical Care",
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T2 - Comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States

AU - Bachhuber, Marcus A.

AU - Southern, William N.

AU - Cunningham, Chinazo O.

PY - 2014

Y1 - 2014

N2 - BACKGROUND:: Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. OBJECTIVE:: To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. DESIGN, SETTING, AND PARTICIPANTS:: Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). MAIN OUTCOME MEASURE:: Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. RESULTS:: Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). CONCLUSIONS:: For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

AB - BACKGROUND:: Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. OBJECTIVE:: To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. DESIGN, SETTING, AND PARTICIPANTS:: Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). MAIN OUTCOME MEASURE:: Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. RESULTS:: Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). CONCLUSIONS:: For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

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