Article
Role of state policies in the adoption of naltrexone for substance abuse treatment.
Georgetown Public Policy Institute, Georgetown University, 3520 Prospect Street NW, 4th Floor, Washington, DC 20007, USA.
Health Services Research (impact factor:
2.16).
07/2008;
43(3):951-70.
DOI:10.1111/j.1475-6773.2007.00812.x
Source: PubMed
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Article: Initial and maintenance naltrexone treatment for alcohol dependence using primary care vs specialty care: a nested sequence of 3 randomized trials.
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ABSTRACT: Naltrexone may improve success in primary care treatment of alcohol dependence (AD). This study tests naltrexone and primary care management (PCM) vs naltrexone and cognitive behavior therapy (CBT) and tests naltrexone maintenance among patients who respond to an initial course of naltrexone combined with PCM vs CBT. A nested sequence of 3 randomized trials was conducted. In study 1, 197 subjects with AD participated in a 10-week comparison of PCM and naltrexone (50 mg/d) vs CBT and naltrexone (50 mg/d). In study 2, 53 PCM responders from study 1 continued in a 24-week placebo-controlled study of maintenance naltrexone. In study 3, 60 CBT responders from study 1 continued in a 24-week placebo-controlled study of maintenance naltrexone and CBT. Study 1: No difference in the response to treatment; 84.1% (74/88) of the PCM patients and 86.5% (77/89) of the CBT patients avoided persistent heavy drinking. Percentage of days abstinent (PDA) declined over time for PCM vs CBT (P =.03). Study 2: Higher response maintenance for PCM and naltrexone (21/26, 80.8%) vs PCM and placebo (14/27, 51.9%; P =.03) and PDA declined more for the placebo group (P =.02). Study 3: The differences between naltrexone vs placebo on maintenance of response (25/30, 83.3% vs 21/30, 70.0%) or PDA did not reach statistical significance. Naltrexone yielded comparable results during the initial 10 weeks of treatment when combined with PCM or CBT. Maintenance of improvement was enhanced by continued naltrexone treatment in the PCM but not in the CBT arm.Archives of Internal Medicine 08/2003; 163(14):1695-704. · 11.46 Impact Factor -
Article: Benefits and risks of increasing restrictions on access to costly drugs in Medicaid.
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ABSTRACT: States are reacting to increased Medicaid drug costs by implementing cost-control policies, such as preferred drug lists (PDLs) and prior authorization. PDLs have risks as well as benefits. Targeting essential drug classes with heterogeneous patient responses and side effects could reduce appropriate care, adversely affect health status, and cause shifts to more costly types of care. Assessing inappropriate use of high-cost drugs before implementing regulations and instituting simple mechanisms to exempt high-risk patients could maximize savings and minimize harm. The current exponential growth in such policies and the limited evidence base justifies investment in research to identify which policies can achieve savings without unintended consequences.Health Affairs 23(1):135-46. · 4.31 Impact Factor -
Article: Policy implications for implementing evidence-based practices.
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ABSTRACT: The authors describe the policy and administrative-practice implications of implementing evidence-based services, particularly in public-sector settings. They review the observations of the contributors to the evidence-based practices series published throughout 2001 in Psychiatric Services. Quality and accountability have become the watchwords of health and mental health services; evidence-based practices are a means to both ends. If the objective of accountable, high-quality services is to be achieved by implementing evidence-based practices, the right incentives must be put in place, and systemic barriers must be overcome. The authors use the framework from the U.S. Surgeon General's 1999 report on mental health to describe eight courses of action for addressing the gap between science and practice: continue to build the science base; overcome stigma; improve public awareness of effective treatments; ensure the supply of mental health services and providers; ensure delivery of state-of-the-art treatments; tailor treatment to age, sex, race, and culture; facilitate entry into treatment; and reduce financial barriers to treatment.Psychiatric Services 01/2002; 52(12):1591-7. · 2.38 Impact Factor
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Keywords
2003 National Survey
96 percent
alcohol-dependent clients
cost-effective treatments
drug costs
general limitations
generic drugs
Medicaid benefits
Medicaid preferred drug lists
naltrexone adoption
pharmaceutical agent-naltrexone-by substance abuse treatment facilities
pharmacy networks
state governments
State Medicaid policies
State policies
state-level policies
substance abuse
substance abuse treatment
Substance Abuse Treatment Services
treatment facilities' naltrexone adoption
