Potential impact of peer support service on SUD treatment engagement following ED visits among Kentucky medicaid beneficiaries

Abstract

Background

Research indicates that peer support has a positive impact on patients with substance use disorders (SUD). Despite promising findings, integrating peer support into SUD treatment remains limited, particularly during the critical transition period between emergency department (ED) discharge and treatment initiation. This study examines the effectiveness of Kentucky-certified Peer Support Specialists (PSS) during that period within a Medicaid population.

Methods

We conducted a retrospective analysis of beneficiaries with SUD who initiated treatment following an ED visit using Kentucky Medicaid claims data from July 1, 2022, to June 30, 2023. We assessed prior health conditions using 12-month lookback period (July 2021–June 2022). We then compared monthly engagement outcomes between beneficiaries who received PSS and those who did not.

Results

PSS was consistently associated with higher odds of treatment engagement across six months. In unadjusted logistic regression models, odds ratios (ORs) for the PSS group ranged from 1.75 (95 % CI: 1.45–2.09) to 4.17 (95 % CI: 3.53–4.91). Adjusted models accounting for age, sex, geographic location, and health conditions yielded ORs between 1.63 (95 % CI: 1.35–1.95) and 3.84 (95 % CI: 3.23–4.55).

Subgroup analysis by sex showed that females receiving PSS had ORs ranging from 1.50 (95 % CI: 1.10–2.05) to 3.77 (95 % CI: 2.80–5.07), while males showed ORs from 1.70 (95 % CI: 1.43–2.14) to 4.22 (95 % CI: 3.43–5.22). Among those with one health condition, PSS effects ranged from Month 1 (OR = 1.41, 95 % CI: 1.03–1.95) to a peak in Month 2 (OR = 4.51, 95 % CI: 3.32–6.13). For those with two conditions, effects increased from Month 1 (OR = 1.76, 95 % CI: 1.33–2.34) to a peak in Month 3 (OR = 4.21, 95 % CI: 3.25–5.45). In the group with three or more conditions, ORs started at 2.49 (95 % CI: 1.43–4.32) and remained high through Month 6 (OR = 3.46, 95 % CI: 2.18–5.48).

Conclusions

Peer support services are associated with the increased likelihood of SUD engagement in Kentucky Medicaid enrollees. Subgroup findings by gender and health complexity highlight its broad effectiveness. These results support expanding access to peer support in Medicaid policy and practice.