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
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.
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
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.