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
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