title: Predictors and outcomes of outpatient mental health care: a 4-year prospective study of elderly Medicare patients with substance use disorders.
abstract: BACKGROUND
  Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital.
  
  
  OBJECTIVE
  The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined.
  
  
  METHODS
  A longitudinal prospective follow-up was performed.
  
  
  METHODS
  Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge.
  
  
  RESULTS
  Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, non-black, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality.
  
  
  CONCLUSIONS
  Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University Medical Center, California 94304, USA. penny.brennan@med.va.gov
authors.forename: P L
authors.initials: PL
authors.lastname: Brennan
authors.forename: C R
authors.initials: CR
authors.lastname: Kagay
authors.forename: J J
authors.initials: JJ
authors.lastname: Geppert
authors.forename: R H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000437:Alcoholism / Q000534:rehabilitation; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000401:mortality / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology