175754 Consumer experiences in accessing behavioral health care and medication use in New Mexico

Wednesday, October 29, 2008: 9:42 AM

Nicole Lanouette, MD , Department of Geriatric Psychiatry, University of California, San Diego, La Jolla, CA
David Folsom, MD, MPH , Department of Geriatric Psychiatry, University of California, San Diego, La Jolla, CA
Danielle L. Fettes, PhD Candidate , Casrc, University of California, San Diego, San Diego, CA
Karen Meador, JD , HSD/BH/South Park, HSD/NM Behavioral Health Collaborative, Santa Fe, NM
Caroline Bonham, MD , Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM
Richard L. Hough, PhD , Health Evaluation and Research Office, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM
Introduction: We used a mixed-methods approach to examine associations between consumer characteristics and behavioral health treatment access and psychotropic medication use in New Mexico. Methods: We undertook structured and semi-structured interviews with 326 help-seeking participants with serious mental illness. Approximately equal numbers of urban and rural and Native American, Hispanic, and White consumers comprised the sample. We administered the Experience of Care and Health Outcomes Survey TM to assess access and medication use, and then conducted logistic regression analyses. Semi-structured interviews offered qualitative data that were subjected to iterative coding procedures. Qualitative and quantitative results were triangulated. Results: Roughly 65.5% of participants needed behavioral health care urgently in the prior year; 63.4% of those usually or always received it promptly. Seventy-eight percent needed non-urgent care; 69.5% of those usually or always secured appointments when wanted. Men (OR=0.33,p<0.05), uninsured consumers (OR=0.48,p<0.01), and Native Americans (OR=0.2,p<0.001) reported less timely treatment access. Overall, 67.1% of participants reported taking medications. Decreased likelihood of medication use was associated with living in a rural county (OR=0.50,p<0.05) and being Native American (OR=0.31,p<0.05). Greater likelihood was associated with having health insurance (OR=2.68,p<0.05) and/or substantial financial difficulties (OR=1.87,p<0.05). Qualitative analyses identified problems accessing medications, including confusing and incomplete formularies, out-of-pocket costs, and time expenditures. Some consumers filed appeals, traveled to Mexico, and used the Indian Health Service to obtain medications. Discussion: Quantitative analyses identified factors associated with poor access to care and medication use, while qualitative results provided detail regarding perceived barriers to and alternative strategies for obtaining medication.

Learning Objectives:
1. Identify demographic and cultural factors associated with access to care and medication use in the early phase of system change. 2. Describe the use of mixed-methods in examining cultural factors in access to care and medication use.

Keywords: Mental Health System, Mental Health Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conduct research in this area.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.