Browsing by Author "Kilgore, Meredith"

Now showing 1 - 5 of 5
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    Cost-effectiveness of a chronic pain intervention for people living with HIV (PLWH)
    (Taylor & Francis, 2018) Merlin, Jessica S.; Westfall, Andrew O.; Johnson, Mallory O.; Kerns, Robert D.; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Clay, Olivio J.; Starrels, Joanna L.; Kilgore, Meredith; Medicine, School of Medicine
    Background: Chronic pain is a common, disabling, and costly comorbidity, particularly in people living with HIV (PLWH). This study developed and pilot tested a pain self-management intervention for chronic pain tailored to PLWH called Skills TO Manage Pain (STOMP). Objectives: Given the additional resources needed to deliver STOMP in HIV clinical settings, an important objective of the pilot study was to assess not only STOMP’s preliminary efficacy, but also its cost-effectiveness. Research design and subjects: The present study draws from a 44-participant, 2-arm randomized pilot trial of the STOMP intervention vs usual care among PLWH and at least moderate chronic pain (Clinicaltrials.gov: NCT02824562). Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER). Costs were considered from the clinic perspective over a 1-year time horizon using real costs from the pilot trial. It was conservatively assumed there would be no costs savings. The Standard Gamble (SG) method was used to directly measure utilities. Results: Thirty-six participants met inclusion criteria for the present analyses. Mean age was 52 years; 61% were female and 86% were black. The total cost of STOMP was $483.83 per person. Using the SG method, the change in QALYs was 0.15, corresponding to an ICER of $3,225. Conclusions: STOMP’s cost/QALY is substantially lower than the $50,000 to $100,000/QALY benchmark often used to indicate cost-effectiveness. Although based on a pilot trial and, therefore, preliminary, these findings are promising, and suggest the importance of cost analyses in future STOMP trials.
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    Impact of Mental Health Parity & Addiction Equity Act on Costs & Utilization in Alabama's Children's Health Insurance Program
    (Elsevier, 2018) Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A.; Kilgore, Meredith; Menachemi, Nir; Caldwell, Cathy; Becker, David; Health Policy and Management, School of Public Health
    Objective: The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 mandates equivalent insurance coverage for mental-health (MH) and substance-use disorders (SUD) to other medical and surgical services covered by group insurance plans, Medicaid and Children's Health Insurance Programs (CHIP). We explored the impact of MHPAEA on enrollees in ALL Kids, the Alabama CHIP. Methods: We use All Kids claims data for October 2008-December 2014. October 2008 through September 2009 marks the period prior to MHPAEA implementation. We evaluated changes in MH/SUD related utilization and program costs, and changes in racial/ethnic disparities in the use of MH/SUD services for ALL Kids enrollees, using two-part models. This allowed analyses of changes from no use to any use, as well as in intensity of use. Results: No significant effect is found on overall MH service-use. There are statistically significant increases in for inpatient visits and length of stay, and some increase in overall MH costs. These increases may not be clinically important, and are concentrated in 2009-2011. Disparities in utilization between African-American and non-Hispanic white enrollees are somewhat exacerbated, while disparities between other minorities and non-Hispanic whites are reduced. Conclusions: Findings indicate that MHPAEA led to a 14.3% increase in inpatient visits, a 12.5% increase in length of inpatient stay, and a 7.8% increase in MH costs. The increases appear limited to 2009-2011, suggesting existing pent-up ‘needs’ among enrollees for added MH/SUD services that resulted in a temporary spike in service use and cost immediately after MHPAEA, and which subsequently subsided.
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    Intervention Mapping to develop a Social Cognitive Theory-based intervention for chronic pain tailored to individuals with HIV
    (Elsevier, 2018-02-19) Merlin, Jessica S.; Young, Sarah R.; Johnson, Mallory O.; Saag, Michael; Demonte, William; Kerns, Robert; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Kilgore, Meredith; Clay, Olivio J.; Pekmezi, Dorothy; Davies, Susan; Medicine, School of Medicine
    Chronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.
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    Mood Disorder Episodes & Diagnosis in Different Settings: What Can We Learn?
    (Juniper, 2018) Sen, Bisakha; Blackburn, Justin; Morrisey, Michael A.; Kilgore, Meredith; Menachemi, Nir; Caldwell, Cathy; Becker, David; Health Policy and Management, School of Public Health
    Objective: Over the past two decades in proportion of costs of mood disorders among children paid for by government insurance programs has increased substantially. The objective of this study is to gain a more in-depth understanding of patterns of mood disorder diagnosis (MDOD) among enrollees in the Alabama Children’s Health Insurance Program, ALL Kids. Method: A retrospective study using claims data from ALL Kids from 2008-2014 was conducted. The proportion of ‘initial’ MDOD incidents occurring in different care settings (inpatient/ED, physician’s office, outpatient), and the predictors of these incidents, were investigated. Patterns of repeated MDOD inpatient/ED incidents were examined. Results: Multinomial logistic regression results show black enrollees have higher relative risk ratios (RRR) of having a MDOD in inpatient/ED setting (RRR: 1.52, p< 0.01), as do Hispanics (RRR: 1.30, p< 0.01). Enrollees who receive the initial diagnosis in an inpatient/ED setting are at high risk of subsequent MDOD incidents in an inpatient setting/ED. There is no significant racial or ethnic difference in the subsequent number of inpatient/ED visits conditional on the location of the initial diagnosis. Conclusions: The pattern of repeated MDOD incidents in inpatient/ED settings may be indicative of acuity of conditions, lack of access to alternate sources of care for mood disorders, or poor adherence to treatment and inadequate home care. Enrollees who do have such an incident may be strong candidates for case management, potentially improving enrollee outcomes as well as reducing program costs by averting avoidable inpatient/ED MDOD incidents.
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    A Randomized Pilot Trial of a Novel Behavioral Intervention for Chronic Pain Tailored to Individuals with HIV
    (Springer Nature, 2018-08) Merlin, Jessica S.; Westfall, Andrew O.; Long, Dustin; Davies, Susan; Saag, Michael; Demonte, William; Young, Sarah; Kerns, Robert D.; Bair, Matthew J.; Kertesz, Stefan; Turan, Janet M.; Kilgore, Meredith; Clay, Olivio J.; Starrels, Joanna; Pekmezi, Dorothy; Johnson, Mallory O.; Medicine, School of Medicine
    Chronic pain is an important and understudied comorbidity in people living with HIV (PLWH). We conducted a pilot trial of Skills TO Manage Pain (STOMP), an innovative social cognitive theory-based pain self-management intervention tailored to PLWH, to assess feasibility, acceptability, and preliminary efficacy. Eligibility criteria included being HIV+, ≥ moderate pain for ≥ 3 months and a score of ≥ 4 on the three-item PEG pain severity and interference scale. Participants were randomized in a 1:1 fashion to STOMP or a usual care comparison. Among 22 participants randomized to STOMP, median session attendance was 9/12 (75%). Of 19 STOMP participants surveyed, 13 reported being "much better" overall since beginning treatment. Brief pain inventory-total scores decreased by 2 points in the intervention group and 0.9 in the control group (p = 0.11). STOMP is feasible, acceptable, and shows preliminary evidence of efficacy and promise for a full-scale trial.