Psychiatric Hospital Outcomes of Dual Diagnosis Patients Under Managed Care

Abstract

The authors compared patterns of psychiatric hospitalization utilization and outcomes between persons with and without co-existing substance-related disorders in a managed care environment by means of a prospective follow-along study of persons hospitalized for psychiatric reasons under the auspices of a large regional managed care firm. Forty-two psychiatric inpatients with comorbid substance disorders and 121 inpatients without coexisting substance disorders were compared across measures of service use and psychiatric acuity. Readmission to the hospital was assessed at 30 days and after 6 months. Patients with coexisting substance disorders spent fewer days in the hospital, but were rehospitalized at a higher rate both within 30 days and (significantly) after 6 months. These results suggest that the revolving-door pattern of service utilization is also present in managed care environments.

PTSD and Substance Use Disorder Among Veterans: Characteristics, Service Utilization and Pharmacotherapy

“…Some substance abuse treatment facilities do not treat patients with a comorbid psychiatric diagnosis (Drake, McHugo, & Noordsy, 1993), and others report that patients with a dual diagnosis leave treatment earlier than others (Leon, Lyons, Christopher, & Miller, 1998). Similar to the current study, these reports demonstrate that service utilization of veterans with PTSD and substance use disorders remains considerably higher than among those with PTSD alone, especially in the case of emergency department use.…”

Substance-induced suicidal admissions to an acute psychiatric service: Characteristics and outcomes

“…Patients with low to moderate psychiatric severity and high addictions severity have been described as comprising Quadrant 3 in the Substance Abuse and Mental Health Services Administration Co-occurring Matrix (U.S. Department of Health and Human Services, 2005) and are, by description, addictions system based; however, as we have demonstrated, they may be found in an acute psychiatric hospital, in the most expensive mental-healthbased level of care. Such patients have also been described (but not SIS rated or analyzed as in this study) by other studies (Beck & Steer, 1989;Blow et al, 1998;Hufford, 2001;Leon et al, 1998;Mann et al, 1999;Zouk et al, 2006). Although rated as more uncooperative, the mostly SIS patients showed more rapid improvement in suicidality and depressive symptoms than those whose admission syndrome was less substance induced.…”

“…This has been done on our units for many years, through daily chemical dependency groups, individual motivational interactions, team planning, medications, 12-step meetings, and discharge planning. Other research indicates that patients with substance-related suicidality are likely to have high rates of recidivism (Blow et al, 1998;Dixon, McNary, & Lehman, 1997;Leon, Lyons, Christopher, & Miller, 1998). We will examine recidivism in a forthcoming study, because in our setting, we provide substantially more substance interventions than these other studies and, hypothetically, we might find less recidivism.…”

“…Despite these separate proximal and distal factor relationships, most studies of substance use and suicidality have used the distal trait marker (diagnosis of substance use disorder) but have not studied the proximal state-dependent marker (degree to which the indexed acute suicidal syndrome was substance induced), despite recent data that proximal factors are most strongly related to the most lethal suicide attempts (Elliott, Pages, Russo, Wilson, & Roy-Byrne, 1996). Both of these issues have been shown to substantially affect admission and discharge type, length of stay (LOS), and response to treatment (Blow et al, 1998;Leon, Lyons, Christopher, & Miller, 1998); further research is needed.…”

Using Information Technology to Evaluate the Detection of Co-Occurring Substance Use Disorders Amongst Patients in a State Mental Health System: Implications for Co-Occurring Disorder State Initiatives

“…Epidemiological studies have found that 51% of individuals with a lifetime mental disorder also have a lifetime history of at least one substance abuse disorder (Grant et al 2004;Kessler et al 2005). Substance use disorders worsen the clinical course for mental health patients by increasing the risk for psychiatric relapses, rehospitalizations, emergency department visits, medication nonadherence, HIV infection, social isolation, and suicide ideation and attempts Clark et al 1999;Drake and Mueser 2000;Hoff and Rosenheck 1998;Hoff and Rosenheck 1999;Jerrell et al 2000;King et al 2000;Laudet et al 2000;Leon et al 1998;Mueser et al 1992;Pirzada et al 1997;Wu et al 1999).…”