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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3082 — Health Service Use in Veterans with Methamphetamine Abuse

Morasco BJO'Neil MEDuckart JP, and Ganzini L, Portland VA Medical Center;

Objectives:
Methamphetamine abuse/dependence (MD) is associated with severe health effects and psychiatric comorbidities, but little is known about the medical utilization of patients with MD. The goal of this study is to describe health service use among Veterans with MD relative to a comparison group of Veterans with an alcohol use disorder (AUD).

Methods:
Using VA administrative data, we identified 718 patients from VISN-20 who were diagnosed with MD between 2003 and 2005, had a positive urine drug screen for amphetamines, and no other substance abuse comorbidities. Data were compared to 744 patients who had diagnoses of AUD and at least one blood level of 80 mg/dl during the same time period. We examined diagnoses and medical utilization for all patients for four years after their index date.

Results:
Patients with MD were younger than patients with AUD (46.2 years vs 53.9 years, respectively). Patients with MD were significantly more likely to be diagnosed with a mood disorder (71% vs 56%), PTSD (33% vs 26%), and a psychotic-spectrum disorder (26% vs 9%). After controlling for age and time until death, patients with MD had more inpatient hospitalizations (3.2 vs 2.3) and longer stays on inpatient psychiatric and substance abuse units. MD patients were more likely to discharge from an inpatient admission against medical advice (OR = 2.7, 95% CI = 1.9-3.8), receive care at three or more different VA medical centers (OR = 2.4, 95% CI = 1.6–3.6), have a behavioral flag (OR = 2.7, 95% CI = 1.9–3.8), and have more total missed appointments (33.0 vs 23.5) during the four-year time frame.

Implications:
Veterans with MD were more likely than Veterans with AUD to be diagnosed with a variety of psychiatric disorders and use more inpatient services. Despite this, care for MD patients was chaotic, as patients were more likely to receive care at multiple VA facilities, to discharge from the hospital against medical advice, and have more missed visits.

Impacts:
Substance abuse services in VA are primarily designed based on the needs of Veterans with AUDs, but these data suggest that MD patients may have special characteristics that need to be considered in developing programs of care.


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