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IIR 08-071 – HSR&D Study

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IIR 08-071
Access to Treatment and Outcomes for Veterans with Substance Use Disorders
Steven Daniel Pizer PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: May 2010 - April 2012

BACKGROUND/RATIONALE:
The number of veterans diagnosed with substance use disorders increased from 366,000 in FY2000 to 533,000 in FY2003, an increase of 31%. This increase is thought to be due to two factors: increasing demand among veterans for substance abuse treatment services and improved screening for substance use disorders in primary care. While demand for VA services has been increasing, the supply of VA services has declined. The total number of VA intensive and standard outpatient treatment programs fell from 158 in FY2000 to 135 in FY2003. Over the same period, the average number of veterans on waiting lists for substance abuse treatment programs increased. Average waiting lists grew 458% for inpatient programs, 36% for residential programs, and 100% for intensive outpatient programs. In response, the Comprehensive VHA Mental Health Strategic Plan included a goal "To restore VHA's ability to consistently deliver state of the art care for veterans with substance use disorders". Under this goal, the Mental Health Strategic Healthcare Group in VA Central Office developed a National Plan to improve access, geographic distribution, and affordability of VA substance use disorder treatment services.

OBJECTIVE(S):
Objective 1. Describe patterns and trends in fiscal, supply, wait time, and utilization variables over the study period, 2002-2005.

Objective 2. Estimate the relationship between fiscal variables, the supply of treatment, and utilization of VA treatment.

Objective 3. Estimate the relationship between access to local treatment and health outcomes for veterans with SUD diagnoses.


METHODS:
This was a retrospective observational cohort study of patient-level administrative data extracted from VA, Medicare, and Medicaid records over the period from January 1, 2001 to December 31, 2005. These data were augmented by program-level survey data from the VA Drug Abuse Program Survey (DAPS) and the National Survey of Substance Abuse Treatment Services (NSSATS). Additional program-level data were used to measure variations in VA and state budgets.

FINDINGS/RESULTS:
Findings from Objectives 1 and 2 indicate that dedicated funding for specialty treatment of Veterans with substance use disorders increased the supply of treatment services, with the proportion of dedicated funds attributable to specific increases in specialty services growing over time. Findings from Objective 3 did not demonstrate an empirical relationship between specialty SUD treatment and hospitalization for ambulatory care sensitive conditions or mortality. Additional preliminary findings suggest that there may be evidence that specialty SUD treatment reduces the likelihood of becoming homeless.

IMPACT:
Ample research documents that participation in treatment reduces substance use and improves a number of directly linked outcomes including the likelihood of employment, stability of personal relationships, involvement with the criminal justice system, and other physical and mental health measures. In this study, we hypothesized that limited access to treatment also has consequences for veterans' ability to successfully manage their own general health, including chronic conditions like diabetes, asthma, coronary artery disease, and chronic obstructive pulmonary disease.

PUBLICATIONS:
None at this time.


DRA: Mental, Cognitive and Behavioral Disorders, Substance Abuse and Addiction, Health Systems
DRE: Treatment - Observational
Keywords: Access, Disparities, Drug abuse, Organizational Structure, Outcomes, Outcomes - Patient, Practice Patterns/Trends, Rural, Substance Use and Abuse, Utilization
MeSH Terms: none

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