Publications by authors named "Pierre K Alexandre"

Background: Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country.

Objective: Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology.

Research Design: Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers.

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Article Synopsis
  • The study investigates how county-level factors influence the "meaningful use" of electronic health records (EHRs) among over 8,400 primary care providers in Florida's Medicaid EHR Incentive Program from 2011 to 2018.
  • Key county-level factors analyzed include rurality, poverty, educational attainment, managed care penetration, population changes, and the number of PCPs per capita, with significant findings linking rurality and poverty to lower rates of MU.
  • The research emphasizes the importance of understanding these county-level influences for policymakers and healthcare managers to effectively promote EHR adoption in underserved communities.
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Objective: The objective of this study was to quantify the rate of provider participation beyond year 1 incentive in the Florida Medicaid Promoting Interoperability (PI) program, formerly the Electronic Health Record Incentive program, and identify the provider and practice characteristics associated with Meaningful Use attestations.

Methods And Materials: We conducted a retrospective cohort study using the 2011-2018 records from the PI program, Provider Participation Database. Bivariate associations between Meaningful Use and categorical and ordinal variables were tested using Chi-square and Mantel-Haenszel Chi-square, respectively, with results informing logistic regressions.

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Medicare spending is projected to increase over the next decade, including for substance use disorders (SUD). Our objective was to determine whether SUDs are associated with higher six-year Medicare costs (1999-2004) among participants in the Baltimore Epidemiologic Catchment Area (ECA) Study. Medicare claims data for the years 1999-2004 from the Centers for Medicare and Medicaid Services were linked to four waves of data from the Baltimore ECA cohort collected between 1981 and 2005 (n=566).

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Background: Many persons with depressive disorder are not treated and associated costs are not recorded.

Aims Of The Study: To determine whether major depressive disorder (MDD) is associated with higher medical cost among Medicare recipients.

Methods: Four waves of the Baltimore-Epidemiologic Catchment Area (Baltimore ECA) Study conducted between 1981 and 2004 were linked to Medicare claims data for the years 1999 to 2004 from the Centers for Medicare and Medicaid Services (CMS).

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It has been documented that about 20% of children and adolescents suffer from a diagnosable mental or addictive disorder in the United States. The high prevalence of children's emotional and behavioral problems (EBP) might have a negative effect on their mothers' labor market outcomes because children with EBP require additional time for treatment. However, these children may require additional financial resources, which might promote mothers' labor supply.

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Unlabelled: Generalized linear models were used to assess the relationship between religious attendance and lifetime smoking status among middle-aged adults (n = 666) sampled from waves three (1993 to 1996) and four (2004 to 2005) of the Baltimore Epidemiologic Catchment Area (ECA) study. Religious attendance once per week or greater as compared to never was inversely associated with smoking status. Future research should explore potential mediating factors of the association between religious attendance and smoking among middle-aged adults in order to gain a greater understanding of the mechanisms underlying this relationship.

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Background: Despite chemical similarities, ADHD stimulants and methamphetamine have distinct use patterns in the community. This study compared the characteristics of nonmedical ADHD stimulants users and methamphetamine users in a household sample.

Methods: In data from the 2009-2011 National Survey on Drug Use and Health, adult and adolescent stimulant users were categorized into three mutually exclusive subgroups: nonmedical ADHD stimulant users only (STM users), methamphetamine users (METH users), and both nonmedical ADHD stimulant and methamphetamine users (STM/METH users).

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A benefit-cost analysis was conducted as part of a clinical trial in which newly-admitted methadone patients were randomly assigned to interim methadone (IM; methadone without counseling) for the first 4 months of 12 months of methadone treatment or 12 months of methadone with one of two counseling conditions. Health, residential drug treatment, criminal justice costs, and income data in 2010 dollars were obtained at treatment entry, and 4- and 12-month follow-up from 200 participants and program costs were obtained. The net benefits of treatment were greater for the IM condition but controlling for the baseline variables noted above, the difference between conditions in net monetary benefits was not significant.

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Objective: Therapies for end-stage renal disease improve quality of life, and survival. In Mexico, clinicians often must choose between different therapies without the availability of comparative outcomes evaluation. The present study evaluates the comparative cost-utility of sirolimus (SIR) versus tacrolimus (TAC) for the primary prevention of graft rejection in renal transplant recipients in Mexico.

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Background: There is limited information on the impact of lifetime depressive disorders on adherence to ART.

Aim: We examined the association between lifetime depressive disorders and adherence to anti-retroviral therapy (ART) among a rural clinic-based HIV positive population. We further explored whether this association was mediated by current depression and moderated by gender.

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Objective: Public and private stakeholders of substance abuse treatment services require economic cost data to guide program evaluations and funding decisions.

Background: Rigorous cost assessments have been conducted for several treatment programs across the United States, but a systematic and comprehensive evaluation of programs in a particular state has never been attempted.

Research Design: The present study recruited all publicly funded treatment programs in the State of Florida and administered the Brief Drug Abuse Treatment Cost Analysis Program.

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Background: HIV treatment programs are in need of brief, valid instruments to identify common mental disorders such as depression.

Aim: To translate and culturally adapt the Self-Reporting Questionnaire (SRQ-20) for use in Uganda and to investigate its psychometric properties in this setting.

Methods: Following an initial translation of the SRQ-20 from English to Luganda, key informant interviews and focus-group discussions were used to produce a culturally adapted version of the instrument.

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Introduction: Previous studies have consistently documented that racial/ethnic minority patients with diabetes receive lower quality of care, based on various measures of quality of care and care settings. However, 2 recent studies that used data from Medicare or Veterans Administration beneficiaries have shown improvements in racial/ethnic disparities in the quality of diabetes care. These inconsistencies suggest that additional investigation is needed to provide new information about the relationship between racial/ethnic minority patients and the quality of diabetes care.

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Objective: To assess the incremental cost-effectiveness of SFC compared with MON for the control of persistent asthma in children.

Methods: We conducted an economic evaluation on a 12-week prospective randomized open-label parallel-group comparison of SFC versus MON in children with symptomatic asthma receiving inhaled corticosteroids and short-acting β2-agonists. Asthma-related medication, unscheduled physician contacts and hospitalizations were collected prospectively.

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Unlabelled: Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico.

Objective: To estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico.

Methods: A previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole.

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Objective: Following efforts made in recent years to have effective mental health treatments based on evidence-based guidelines, a working-definition of a minimum level of 'adequate mental health care (AMHC)' for serious mental illness (SMI) was developed in the literature. However, little is known about racial/ethnic disparities in receipt of adequate mental health care for SMI. The objective of this study was to examine disparities among Whites and non-Whites in receiving adequate mental health care for past-year major depressive episodes (MDE).

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Article Synopsis
  • The study explores the role of peers in drug procurement among adolescents and aims to identify factors related to drug dealing among Black and White youths.
  • The sample included over 13,000 participants from the National Survey on Drug Use and Health, and regression analysis was used to discern the factors influencing drug dealing behaviors.
  • Results show that White youths’ drug dealing is linked to diverse substance use and socioeconomic status, while Black youths’ drug dealing is mainly associated with marijuana and local drug availability, highlighting the need for targeted interventions.
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This study identifies determinants of adolescents' propensity to use outpatient mental care as well as factors predicting number of visits after contact with a provider was made. We examined three types of treatment outlets: day treatment program (DTP); mental health clinic (MHC); and private specialty services (PSS). Among youth, 1.

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Article Synopsis
  • The study looked at how psychological distress (PD) affects employment among African-Americans and non-Hispanic Whites using data from the 2002-2003 U.S. National Survey on Drug Use and Health.
  • Regardless of race, psychological distress was linked to lower chances of being employed, with a 7.4% decrease for African-Americans and a 5.3% decrease for Whites.
  • The research also indicated that 61% of the employment gap between White and African-American individuals with PD was due to differences in resources or qualifications, while 39% of the gap was due to unexplained factors, suggesting the need for targeted policies to improve employment outcomes for minorities.
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Article Synopsis
  • This study aimed to investigate racial and ethnic disparities in access to adequate mental health care for Caucasian and Hispanic youths experiencing major depressive episodes.
  • Data were gathered from the 2005 National Survey on Drug Use and Health, involving over 1,400 youths aged 12 to 17.
  • Findings revealed that 34% of youths received adequate care, with Caucasian youths receiving significantly more adequate treatment (36%) compared to Hispanic youths (27%), highlighting the influence of health insurance on access to care.
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  • Among American youth aged 1 to 17, those aged 12 to 17 are the biggest consumers of outpatient mental health services, according to a 2005 national survey.
  • The study analyzed factors influencing service use across various treatment settings, finding lifetime depression, anxiety, delinquency, drug dependence, and Medicaid status to be strong predictors.
  • While some factors seemed relevant initially, they lost significance when considering other influences, highlighting the need for careful interpretation regarding the study's limitations and its implications for research and policy.
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The objective of this study was to identify long-term factors associated with substance use problem among individuals affected by severe mental illness. Prospective data come from the 1994, 1998, and 2000 waves of the Maryland Mental Health Outcomes Survey conducted among a sub-cohort of adult Medicaid recipients affected by serious mental illness. We estimated factors associated with alcohol and drug problem, as well as a hierarchy of substance use problem severity constructed from the alcohol and drug problem outcomes.

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  • The study analyzed data from two national surveys to investigate the link between ecstasy (MDMA) use and low academic achievement among adolescents.
  • Findings showed that ecstasy use had a stronger association with low academic performance compared to alcohol/tobacco use and was also more linked to poor academic outcomes than marijuana in one of the surveys.
  • The results suggest that prevention programs should focus on informing adolescents about the potential negative impact of ecstasy on their school performance.
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Article Synopsis
  • The study investigated the link between high sensation-seeking, drug use among friends, and low parental monitoring with ecstasy (MDMA) use among adolescents aged 12-18 in the U.S.
  • High sensation-seekers showed a greater likelihood of using ecstasy, marijuana, and alcohol/tobacco compared to low sensation-seekers, with stronger connections for ecstasy use relative to other substances.
  • The findings suggest that school prevention programs should focus on high sensation-seekers and promote friendships with peers who do not use drugs.
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