Outpatient treatment entry and health care utilization after a combined medical/substance abuse intervention for hospitalized medical patients

Factors identifying high-frequency and low-frequency health service utilization among substance-using adults

“…Interventions that increased the availability of primary care sites (Kerr et al, 2004) and colinked substance abuse treatment with medical treatments (O'Toole, Strain, Wand, McCaul, & Barnhart, 2002) while increasing ambulatory care utilization have not always been able to reduce ED use. Homeless substance-using adults were able to triage specific hypothetical health needs and scenarios to different care sites, but it is not clear whether this holds true for actual events or for nonhomeless persons (O'Toole, Gibbon, Hanusa, & Fine, 1999a).…”

Patient Perspective, Complexities, and Challenges in Managed Care

“…The more aberrant the behavior, the higher the risk of developing addiction. 9 Risk tools described earlier in this supplement for assessing aberrant behavior should be utilized. To reduce or avoid the risk of abuse, physicians must implement adherence monitoring programs.…”

“…For example, they are 6.7 times more likely than nonabusers to be hospitalized, and 2.3 times more likely to utilize the emergency department. 9 Emergency department (ED) physicians, like other health care providers, often struggle to distinguish patients with legitimate pain from those reporting pain fraudulently to obtain narcotic prescriptions for abuse or diversion, as pain is principally subjective. 10 There is also a disconnect in tracking patients who utilize the ED for obtaining pain medications, as they are not identified on prescription monitoring programs set up by the MCOs.…”

“…Risk stratification and assessing aberrant drug related behaviors are important and can be done with tools currently available to practitioners. 9,11,12 Pain and opioid dependent patients must be provided with tools to enable them to cope with stressful situations and treatment for comorbid conditions, such as depression. 9,12 Patients must be motivated to stay in therapy using integrated approaches to therapy including behavior modifications, employee assistance programs, and coverage of treatments by managed care organizations.…”

After discharge from hospital, where do we go? Follow-up of clients with mental illness and/or addiction: 30 days post-acute care.

“…O'Toole et al (2002) emphasize that hospitals with psychiatric based services have challenges in effectively treating patients with substance use disorders. Glasby and Lester (2004) note that people admitted to hospitals for mental illnesses and addiction should only stay as long as necessary not only because of high health care costs but possible outcomes of patients experiencing depression and increased dependence on hospital services.…”