• Am J Drug Alcohol Abuse · Jan 2018

    High inpatient utilization among Veterans Health Administration patients with substance-use disorders and co-occurring mental health conditions.

    • Janelle M Painter, Carol A Malte, Anna D Rubinsky, Timothy R Campellone, Amanda K Gilmore, John S Baer, and Eric J Hawkins.
    • a VA Puget Sound Health Care System , Seattle Division , Seattle , WA , USA.
    • Am J Drug Alcohol Abuse. 2018 Jan 1; 44 (3): 386-394.

    BackgroundSubstance-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.ObjectivesTo examine the prevalence, type, and predictors of HIU among patients with SUD and co-occurring mental health conditions.MethodsService 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.ResultsPrevalence 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.ConclusionsSubstantial 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.

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