• Christine Laine, Yi-Ting Lin, Walter W Hauck, and Barbara J Turner.
• Division of Internal Medicine, Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19104, USA.
• Med Care. 2005 Oct 1;43(10):985-95.

BackgroundDrug users rely heavily on emergency departments (EDs) for care. Medical and other services in outpatient drug treatment clinics may reduce demand for ED care.ObjectiveThe objective of this study was to examine the association of services in drug treatment clinics with repeated ED use by clinic patients.DesignThis study consisted of telephone interviews of directors of a stratified random sample of 125 New York state outpatient drug treatment clinics linked to Medicaid claims for patients with long-term (>or=6 months) treatment at these clinics.PatientsThis study comprised a total of 8397 Medicare enrollees in surveyed clinics in 1996 to 1997.MeasurementsThe surveys addressed drug treatment; general medical, HIV, alcohol, and social support services; location of selected services; primary care, HIV specialty, and mental health provider staffing levels; accessibility; and academic affiliation. From Medicaid claims, we defined patient demographic, clinical, and healthcare variables. Logistic regression models examined associations of availability of onsite medical services with repeated (2 or more) ED visits in 1997, adjusted for patient characteristics and patient clustering in clinics.ResultsRepeated ED visits occurred in 15% of the cohort and were less likely when medical services were all onsite versus more distant (12.9% vs 16.8%, P<0.001). An interaction showed that onsite medical care was associated with less ED use only in low-volume (ConclusionsGreater onsite medical care in low- and moderate-volume drug treatment clinics was associated with less repeated ED use.

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