Regular article
Post-Discharge Treatment Engagement Among Patients with an Opioid-Use Disorder

https://doi.org/10.1016/j.jsat.2016.07.004Get rights and content

Highlights

  • This study found that only 17% of privately insured patients who had an opioid-related hospitalization engaged in postdischarge SUD services within 30 days of their discharge.

  • Patients had higher odds of engaging in postdischarge SUD treatment if they had a history of behavioral health outpatient visits prior to their hospitalization.

  • Patients admitted with a principal diagnosis of an SUD or who had a secondary diagnosis for alcohol dependence or an additional SUD on their index admission were also more likely to engage in postdischarge SUD treatment.

  • Patients that were admitted for an opioid overdose were significantly less likely to engage in appropriate behavioral health care after hospitalization. Two additional factors that had a negative effect on SUD treatment after hospitalization were being admitted through an ED and leaving the hospital against medical advice.

  • Postdischarge planning is a clear point of intervention that needs to be addressed for patients hospitalized for an opioid use disorder. Encouraging successful transitions from inpatient care to less intensive outpatient care is a key competent of integrated substance use care. Patients who receive follow-up services after an inpatient stay are at lower risk of being re-admitted and generally have more positive treatment outcomes. The findings from this study can inform the delivery of treatment services that will sustain long-term recovery of patients with an SUD.

Abstract

Introduction

Opioid misuse is a growing public health problem, and estimates show a 150% increase in opioid-related hospital stays over the last two decades. This study examined factors associated with substance use treatment engagement following a hospitalization for opioid use disorder or overdose.

Methods

This study analyzed the Truven Health Analytics MarketScan® Commercial Claims and Encounters (CCAE) database for 2010 through 2014 to study post-hospitalization substance use disorder (SUD) treatment of individuals aged 18–64 who had an inpatient admission for an opioid-use disorder or opioid overdose. Engagement in post-discharge SUD treatment was defined as having at least two unique outpatient visits within 30 days of a hospitalization. Generalized estimating equations (GEEs) with a binomial link were used to determine the factors associated with SUD treatment engagement.

Results

Only 17% of patients engaged in SUD treatment within 30 days of hospital discharge. A behavioral health outpatient visit prior to the SUD admission increased the odds of engaging in SUD treatment by 1.34 (CI: 1.25–1.45), an antidepressant prescription drug fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07–1.21), a benzodiazepine fill prior to the SUD admission increased the odds by 1.14 (CI: 1.07–1.21), a principal diagnosis for an SUD at index admission increased the odds by 2.13 (CI: 1.97–2.30), an alcohol-related disorder diagnosis at index admission increased the odds by 3.13 (CI: 2.87–3.42), and an additional SUD diagnosis at the index admission increased the odds by 2.72 (CI: 2.48–2.98).

Conclusions

We found low rates of SUD treatment engagement following hospitalizations for opioid use disorders and overdoses. Patients with prior engagements with behavioral health providers were more likely to engage in follow-up care; therefore, providers may need to focus additional efforts on patients admitted to the hospital with opioid-use disorders who do not have an existing provider relationship.

Keywords

Post-discharge treatment
Opioid-use disorder
Patient
Opioid related hospitalization

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Disclaimer: The views expressed here are those of the authors and do not necessarily reflect the views of the Substance Abuse and Mental Health Services Administration (SAMHSA) or the U.S. Department of Health and Human Services (DHHS).

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