title: Outpatient treatment entry and health care utilization after a combined medical/substance abuse intervention for hospitalized medical patients.
abstract: BACKGROUND
  Drug-abusing patients utilize extensive amounts of health services resources, yet the acute medical hospitalization has typically not been used effectively to engage patients in substance abuse treatment.
  
  
  OBJECTIVE
  To assess the effect of an integrated substance abuse/acute medical care day hospital (DH) intervention.
  
  
  METHODS
  Prospective, consecutive chart review of patients referred to a day hospital program from the medicine service at an urban tertiary care teaching hospital. From the referral cohort, a comparison group receiving usual care was identified.
  
  
  METHODS
  One hundred twenty adult medicine inpatients with active substance abuse and self-identified motivation to enter treatment.
  
  
  METHODS
  Outpatient substance abuse treatment entry and post-intervention health services utilization.
  
  
  RESULTS
  Following DH treatment, 50.6% entered further outpatient substance abuse treatment (vs 2.4% comparison patients; P <.001). There was a significant increase in ambulatory medical visits for DH patients (pre-6 month 0.49 vs post-6 month 3.46; P <.001), greater than the change noted for comparison patients. However, there was no difference noted in pre-post hospitalization or emergency department utilization following the DH intervention.
  
  
  CONCLUSIONS
  A DH program for substance abusing hospitalized medicine patients that introduces substance abuse treatment during treatment for an acute medical illness does appear to improve outpatient substance abuse treatment entry and ambulatory care utilization after hospital discharge.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Md., USA. totoole@jhmi.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Eric C
authors.initials: EC
authors.lastname: Strain
authors.forename: Gary
authors.initials: G
authors.lastname: Wand
authors.forename: Mary E
authors.initials: ME
authors.lastname: McCaul
authors.forename: Matthew
authors.initials: M
authors.lastname: Barnhart
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D015813:Substance Abuse Detection; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000628:therapy*