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24. Utilization of Department of Veterans Affairs (VA) Health Care Services by Veterans Receiving Publicly Funded Substance Abuse Services in Washington State

C Maynard, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; Department of Health Services, University of Washington; DR Kivlahan, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System; Department of Psychiatry and Behavioral Sciences, University of Washington; KL Sloan, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System; Department of Psychiatry and Behavioral Sciences, University of Washington; A Krupski, Washington State Department of Social and Health Services, Division of Alcohol and Substance Abuse; AJ Saxon, Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System; Department of Psychiatry and Behavioral Sciences, University of Washington

Objectives: Many veterans who receive health care services in the VA also receive services outside the VA (e.g., patients eligible for Medicare, those with acute myocardial infarction). For VA patients with substance use disorders (SUD), non-VA SUD treatment may reflect insufficient access to VA specialty SUD care or poorly coordinated care across systems, potentially resulting in inefficient resource utilization and suboptimal outcomes. This analysis reports how commonly VA patients receive different modalities of specialty care for SUD only in publicly funded programs in Washington State or in both VA and non-VA systems.

Methods: To identify VA patients who receive SUD treatment from publicly funded agencies in Washington State, we matched records from the national VA patient treatment and outpatient care files with those from the Treatment Assessment Report Generation Tool (TARGET), a database maintained by the Division of Alcohol and Substance Abuse of the Washington State Department of Social and Health Services. Records were matched on the basis of social security number, last name, date of birth, and gender. SUD treatment was classified according to treatment modalities in TARGET and DSS and bed section codes in VA databases.

Results: From January 1996 to May 2000, there were 2649 dual-system individuals who received SUD treatment in TARGET facilities and received any VA health care. Their mean age was 43 (SD=10) years and 93% were men. There were 1489 (56%) dual-system veterans who also received specialty SUD treatment in VA facilities. The number of dual-system veterans receiving SUD treatment in TARGET facilities ranged from 811 in 1996 to 1043 in 1998. Nearly all non-VA treatment was provided on an outpatient basis with minimal use of residential treatment. Since 1996, 37% of dual-system veterans were hospitalized at least once in VA medical centers and 77% of these individuals were hospitalized in a specialty SUD or general psychiatry bed section. Over the 4+ years, 1405 (53%) dual-system veterans received any specialty SUD outpatient care in VA, with the annual proportion decreasing from 44% in 1996 to 38% in 1999. Among dual-system women (n=191) only 76 (40%) received specialty SUD treatment in VA compared to 58% of dual system men (p<0.0001). The number of dual-system veterans receiving opioid agonist treatment (OAT) in either care system increased from 98 in 1996 (55% in TARGET only) to 189 in 1999 (68% in TARGET only) with the number receiving OAT in VA facilities increasing modestly from 44 in 1996 to 61 in 1999.

Conclusions: Each year since 1996 in Washington State, a substantial number of VA patients received SUD treatment in non-VA programs, but not in VA SUD specialty care. An even larger number received SUD treatment in both systems. Access to VA specialty SUD treatment appears especially limited for women veterans and veterans in need of Opiate Agonist Treatment.

Impact: The use of non-VA care for SUD by hundreds of VA patients per year in Washington State suggests insufficient access to VA specialty SUD treatment. There may be opportunities to improve cost-effective coordination and continuity of care for these dual system veterans.