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Articles
Published Online: 18 April 2023

Uncovering Barriers to Engagement in Substance Use Disorder Care for Medicaid Enrollees

Irene Falgas-Bague, M.D., Ph.D. [email protected], Jenny Zhen-Duan, Ph.D., Caroline Ferreira, M.A., M.Ed., Sara A. Tahanasab, Fernando Cuervo-Torello, B.A., Marie Fukuda, B.A., Sheri L. Markle, M.I.A., and Margarita Alegría, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 74, Number 11
https://doi.org/10.1176/appi.ps.20220193
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Abstract

Objective:

The authors aimed to uncover factors that affect engagement in substance use disorder treatment among Medicaid beneficiaries in New York State.

Methods:

The authors conducted 40 semistructured interviews with clients, plan administrators, health care providers, and policy leaders directly involved with substance use care in New York State. Data were analyzed with thematic analysis.

Results:

Main themes resulting from analysis of the 40 interviews showed that most stakeholders agreed that a need exists to better integrate psychosocial services into behavioral health care systems; that systemic stigma, stigma from providers, and lack of cultural responsiveness in the substance use care system hinder engagement in and provision of high-quality care; and that rural health care networks with coordinated models benefit clients’ engagement in care.

Conclusions:

Stakeholders involved in care for substance use disorder perceived a lack of integration of resources to meet clients’ social needs, the presence of stigma, and low levels of cultural and linguistic capacity as key factors contributing to low engagement in and low quality of care for substance use disorder. Future interventions should address social needs within the therapeutic regimen and modify curricula in clinical training to reduce stigma and increase cultural competence.

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Supplementary Material

File (appi.ps.20220193.ds001.docx)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 74 • Number 11 • November 01, 2023
Pages: 1116 - 1122
PubMed: 37070259

History

Received: 6 April 2022
Revision received: 10 March 2023
Accepted: 13 March 2023
Published online: 18 April 2023
Published in print: November 01, 2023

Keywords

  1. Alcohol abuse
  2. Drug abuse
  3. Public-sector psychiatry
  4. Quality improvement
  5. Adherence
  6. Stakeholder perspective

Authors

Affiliations

Irene Falgas-Bague, M.D., Ph.D. [email protected]
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Jenny Zhen-Duan, Ph.D.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Caroline Ferreira, M.A., M.Ed.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Sara A. Tahanasab
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Fernando Cuervo-Torello, B.A.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Marie Fukuda, B.A.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Sheri L. Markle, M.I.A.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Margarita Alegría, Ph.D.
Disparities Research Unit, Massachusetts General Hospital, Boston (all authors); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland (Falgas-Bague); Department of Psychiatry, Harvard Medical School, Boston (Zhen-Duan, Alegría).
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Notes

Send correspondence to Dr. Falgas-Bague ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This study was supported by NIH (award R01 DA-044526 to Drs. Alegría, Zhen-Duan, and Falgas-Bague, Ms. Fukuda, and Ms. Markle).The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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