TY - JOUR
T1 - The effect of integrated medical-substance abuse treatment during an acute illness on subsequent health services utilization
AU - O'Toole, Thomas P.
AU - Pollini, Robin A.
AU - Ford, Daniel E.
AU - Bigelow, George
PY - 2007/11
Y1 - 2007/11
N2 - BACKGROUND: The acute care hospital provides a context for engaging difficult to reach patients in substance abuse treatment (SAT); however, little is known regarding the effects of such engagement on subsequent health services utilization. We examined whether a structured day hospital (DH) intervention integrating SAT and medical care during an acute medical hospitalization would reduce subsequent emergency department (ED) use and rehospitalization compared with a control group receiving usual medical care and referral to intensive outpatient SAT. METHODS: Between October 2001 and June 2002, we enrolled 390 hospitalized substance using patients in a nonrandomized clinical trial. Once stabilized, patients were assigned to either the DH intervention (n = 63) or usual care control group (n = 327). Baseline interview and chart review collected data on demographics, substance use, and acute and chronic medical conditions. Subsequent chart review collected data on ED, hospital and ambulatory care utilization in the 6 months pre-enrollment and 6 months postdischarge. Univariate and multiple logistic regression methods were used to assess the independent effects of the DH intervention on postdischarge health care utilization. RESULTS; Overall 25%, 48%, and 42% reported ≥3 ED episodes, ≥1 rehospitalization, and ≥1 ambulatory care visit during the postdischarge period. Subjects who completed the DH intervention were significantly less likely to have ≥3 ED episodes (AOR = 0.27; 95% CI, 0.08-0.89) and more likely to have ≥1 ambulatory care visit (AOR = 4.05; 95% CI, 1.44-11.37) than the usual care group. No similarly beneficial effects were seen for patients who initiated but did not complete the DH intervention. CONCLUSIONS: A DH model that engages acutely ill substance using patients in integrated medical and substance abuse treatment can positively influence subsequent health care seeking behavior.
AB - BACKGROUND: The acute care hospital provides a context for engaging difficult to reach patients in substance abuse treatment (SAT); however, little is known regarding the effects of such engagement on subsequent health services utilization. We examined whether a structured day hospital (DH) intervention integrating SAT and medical care during an acute medical hospitalization would reduce subsequent emergency department (ED) use and rehospitalization compared with a control group receiving usual medical care and referral to intensive outpatient SAT. METHODS: Between October 2001 and June 2002, we enrolled 390 hospitalized substance using patients in a nonrandomized clinical trial. Once stabilized, patients were assigned to either the DH intervention (n = 63) or usual care control group (n = 327). Baseline interview and chart review collected data on demographics, substance use, and acute and chronic medical conditions. Subsequent chart review collected data on ED, hospital and ambulatory care utilization in the 6 months pre-enrollment and 6 months postdischarge. Univariate and multiple logistic regression methods were used to assess the independent effects of the DH intervention on postdischarge health care utilization. RESULTS; Overall 25%, 48%, and 42% reported ≥3 ED episodes, ≥1 rehospitalization, and ≥1 ambulatory care visit during the postdischarge period. Subjects who completed the DH intervention were significantly less likely to have ≥3 ED episodes (AOR = 0.27; 95% CI, 0.08-0.89) and more likely to have ≥1 ambulatory care visit (AOR = 4.05; 95% CI, 1.44-11.37) than the usual care group. No similarly beneficial effects were seen for patients who initiated but did not complete the DH intervention. CONCLUSIONS: A DH model that engages acutely ill substance using patients in integrated medical and substance abuse treatment can positively influence subsequent health care seeking behavior.
KW - Health services utilization
KW - Integrated substance abuse treatment
KW - Medical comorbidities
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U2 - 10.1097/MLR.0b013e318127142b
DO - 10.1097/MLR.0b013e318127142b
M3 - Article
C2 - 18049353
AN - SCOPUS:37349100471
SN - 0025-7079
VL - 45
SP - 1110
EP - 1115
JO - Medical care
JF - Medical care
IS - 11
ER -