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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3065 — Patterns of Health Services Use Associated with VA Substance Abuse Treatment

Author List:
Stecker TA (CAVHS)
Curran G (CAVHS)
Han X (UAMS)
Booth B (CAVHS)

Objectives:
Previous research has documented cost-offset effects for inpatient substance abuse (SA) treatment in the VA. However, beginning in the mid-1990’s, VA treatment services for substance disorders shifted focus from inpatient to outpatient services. This study examined service utilization associated with receiving intensive outpatient (IOP) SA treatment. We hypothesized that veterans receiving more intense SA treatment would have greater post-treatment reductions in medical inpatient utilization.

Methods:
VA national databases were used to identify all veterans receiving IOP SA treatment in FY99. Changes in the use of health services (two years pre-treatment compared to two years post-treatment) were examined. Three IOP treatment groups were defined: veterans attending 1-5 IOP visits (n=2,384), 6-14 IOP visits (n=2,940), and >15 IOP visits (n=3,005). Additionally, a matched non-treatment group was defined as veterans in primary care with a secondary substance use diagnosis and no SA treatment in FY99 (n=7,328). General medical, psychiatric, and substance abuse encounters in inpatient and outpatient settings were retrieved for the four years. Generalized estimating equations analyses were used to compare changes in service utilization across the three IOP groups controlling for demographic characteristics and comorbidity.

Results:
Total outpatient visits increased in all three treatment groups after IOP, with the largest increase observed in the group with 15+ visits (mean visits 5, 44, 57 respectively). In comparison, total visits decreased in the non-treatment group (-7). This pattern was similar across settings (general medical, psychiatric, and substance abuse). Total inpatient days decreased among the four groups, with the non-treatment group having the least amount of decrease (mean change in days .34, .32, .18, .03 respectively). Results from the generalized estimating equation analyses indicated that these observed differences in utilization were statistically significant.

Implications:
Results indicated that more intense IOP treatment is associated with increases in subsequent psychiatric, substance use, medical, and total outpatient care and decreases in expensive inpatient care.

Impacts:
Return to inpatient SA treatment is unlikely in the VA. Therefore VA managers and policy makers need to understand patterns of service use associated with IOP. The observed increases in outpatient service use may indicate appropriate linkages during SA treatment.


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