Tracy Stecker1, Geoffrey M Curran, Xiaotong Han, Brenda M Booth. 1. Veterans Affairs Health Services Research and Development, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, 152/NLR, 2200 Fort Roots Drive, North Little Rock, Arkansas 72114, USA. steckertracy@uams.edu
Abstract
OBJECTIVE: This study examined service use and costs associated with receiving intensive outpatient (IOP) substance-use treatment. METHOD: Veterans Affairs national databases were used to identify all veterans receiving IOP substance-use treatment in fiscal year (FY) 1999. Changes in the use of health services (2 years pretreatment compared with 2 years posttreatment) were examined. Three IOP treatment groups were defined: (1) veterans attending 1-5 IOP visits (n=2,384), (2) 6-14 IOP visits (n=2,940), and (3) >or= 15 IOP visits (n=3,005). In addition, a demographically matched no-treatment group was defined as veterans in primary care with a substance-use diagnosis and no substance-use treatment in FY 1999 (n = 7,328). General medical, psychiatric, and substance-use encounters in inpatient and outpatient settings were retrieved for the 4 years. Generalized estimating equations analyses were used to compare changes in service use 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 >or= 15 visits (mean visits = 5, 44, and 57, respectively). In comparison, total visits decreased in the no-treatment group (-7). This pattern was similar across settings (general medical, psychiatric, and substance use). Total inpatient days decreased among the four groups, with the no-treatment group having the least amount of decrease (mean change in days = .34, .32, .18, and .03, respectively). Analysis of cost data showed similar findings. CONCLUSIONS: 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.
OBJECTIVE: This study examined service use and costs associated with receiving intensive outpatient (IOP) substance-use treatment. METHOD: Veterans Affairs national databases were used to identify all veterans receiving IOP substance-use treatment in fiscal year (FY) 1999. Changes in the use of health services (2 years pretreatment compared with 2 years posttreatment) were examined. Three IOP treatment groups were defined: (1) veterans attending 1-5 IOP visits (n=2,384), (2) 6-14 IOP visits (n=2,940), and (3) >or= 15 IOP visits (n=3,005). In addition, a demographically matched no-treatment group was defined as veterans in primary care with a substance-use diagnosis and no substance-use treatment in FY 1999 (n = 7,328). General medical, psychiatric, and substance-use encounters in inpatient and outpatient settings were retrieved for the 4 years. Generalized estimating equations analyses were used to compare changes in service use 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 >or= 15 visits (mean visits = 5, 44, and 57, respectively). In comparison, total visits decreased in the no-treatment group (-7). This pattern was similar across settings (general medical, psychiatric, and substance use). Total inpatient days decreased among the four groups, with the no-treatment group having the least amount of decrease (mean change in days = .34, .32, .18, and .03, respectively). Analysis of cost data showed similar findings. CONCLUSIONS: 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.
Authors: Alexander Y Walley; Michael Paasche-Orlow; Eugene C Lee; Shaula Forsythe; Veerappa K Chetty; Suzanne Mitchell; Brian W Jack Journal: J Addict Med Date: 2012-03 Impact factor: 3.702