2002. Longitudinal Changes in Health Care Utilization of VA Outpatients with Substance Use Disorder
C Lie, Program Evaluation and Resource Center, JD McKellar, Program Evaluation and Resource Center, KN Humphreys, Program Evaluation and Resource Center

Objectives: Since 1998 the number of outpatients diagnosed with a substance use disorder (SUD) in the VAHCS has increased 42% while specialized services for this population were contracting. To better understand this striking change, this study looked at these SUD outpatients’ utilization of specialized SUD care, psychiatric care, and medical care in fiscal years 1998 through 2001.

Methods: SUD outpatients were identified from the VA National Patient Care Database as those with diagnoses of alcohol and/or drug dependence, abuse, or psychoses (based on the ICD-9-CM International Classification of Diseases). Many (23%) also had concomitant Axis I and/or Axis II psychiatric disorders.  Outpatient clinic visits were totaled for patients in each fiscal year using the following categories: specialized care, psychiatric care, and medical care.

Results: From 1998 to 2001 both the number of specialized SUD and psychiatric care visits decreased by 5% and 4%, respectively.  Conversely, the number of medical care visits showed an increase of 16% for the same time period.  The number of SUD outpatients seen in any specialized care setting has declined from 98,867 in FY1998 to 85,973 in FY2001 while the total number of outpatients with a SUD diagnosis has increased from 272,414 in FY1998 to 387,081 in FY2001.

Conclusions: From 1998-2001 the decline in the number of specialized SUD and psychiatric care visits corresponded with an increase in the number of medical care visits.  Given the four-year trend of divergence in the number of patients treated in specialized care relative to the number of patients identified with a SUD, the increased utilization of medical care for SUD patients is likely to continue.

Impact: With a decline in the number of SUD specialty services, SUD patients may be seeking treatment in more costly medical and psychiatric programs.  Patients identified with a SUD should be better linked to specialized SUD treatment programs, where they can receive more appropriate care.