High Inpatient Utilization Among Veterans Health Administration Patients with Substance Use Disorders and Co-occurring Mental Health Conditions
Autor: | John S. Baer, Timothy R. Campellone, Amanda K. Gilmore, Carol A. Malte, Janelle M. Painter, Anna D. Rubinsky, Eric J. Hawkins |
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Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
Adult
Male Mental Health Services medicine.medical_specialty Substance-Related Disorders Medicine (miscellaneous) Veterans Health behavioral disciplines and activities Article 03 medical and health sciences 0302 clinical medicine Health care mental disorders medicine Humans 030212 general & internal medicine Psychiatry health care economics and organizations Aged Veterans Inpatients business.industry Mental Disorders Inpatient utilization Middle Aged Patient Acceptance of Health Care medicine.disease Veterans health Mental illness Mental health Confidence interval humanities United States 030227 psychiatry Psychiatry and Mental health Clinical Psychology United States Department of Veterans Affairs Schizophrenia Diagnosis Dual (Psychiatry) Health Care Surveys Emergency medicine behavior and behavior mechanisms Female Substance use business |
Popis: | Background. Substance-use disorders (SUDs) are common and costly conditions. Understanding high inpatient utilization (HIU) among patients with SUD can inform the development of treatment approaches designed to reduce healthcare expenditures and improve service quality. Objectives. To examine the prevalence, type, and predictors of HIU among patients with SUD and co-occurring mental health conditions. Methods. Service utilization and demographic and clinical variables were extracted from a national sample of Veterans Health Administration (VA) patients with SUD-only [n = 148,960 (98.3% male)], SUD plus serious mental illness ([i.e. schizophrenia- and/or bipolar-spectrum disorders; SUD/SMI; n = 75,913 (91.6% male)], and SUD plus other mental illness [SUD/MI; n = 245,675 (94.6% male)]. Regression models were used to examine HIU during a follow-up year. Results. Prevalence of HIU among the SUD-only group was 6.2% (95% confidence interval (CI): 6.1%–6.3%) compared with 22.7% (95% CI: 22.4%–23.0%) and 9.7% (95% CI: 9.6%–9.8%) among the SUD/SMI and SUD/MI groups, respectively. Patients with SUD/MI represented nearly half of the HIU sample. Primary type of inpatient service use varied by comorbidity: SUD-only = medicine; SUD/SMI = psychiatric; SUD/MI similar use of psychiatric, SUD-related, and medicine. Predictors of HIU were generally similar across groups: older age, unmarried, homelessness, suicide risk, pain diagnosis, alcohol/opioid/sedative-use disorders, and prior-year emergency department/inpatient utilization. Conclusions. Substantial reductions in HIU among an SUD population will likely require treatment approaches that target patients with less-severe mental health conditions in addition to SMI. Cross-service collaborations (e.g., integration of medical providers in SUD care) and interventions designed to target issues and/or conditions that lead to HIU (e.g., homeless care services) may be critical to reducing HIU in this population. |
Databáze: | OpenAIRE |
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