Health care utilization of carpenters with substance abuse-related diagnoses.
BACKGROUND
Persons in the construction trades in the US have high rates of alcohol and substance abuse. We had the unique opportunity to evaluate health care utilization through private insurance and workers' compensation for a group of carpenters at high risk of injury and substance abuse.


METHODS
We identified a cohort of union carpenters. Their claims for medical care through union insurance and workers' compensation, and appropriate measures of time at risk were documented. Using methods of indirect standardization, we compared utilization and costs between carpenters with and without alcohol and substance-abuse related diagnoses (ASRD).


RESULTS
Through private insurance, those with ASRD had 10% higher outpatient utilization and 2.1 times higher rates of hospitalizations for injury care; 2.6 times higher rates of outpatient care; and 2.9 times higher inpatient admissions for non-injury care. Individuals with ASRD had only modestly increased rates (10%) of outpatient utilization through workers' compensation.


CONCLUSIONS
These findings support the need for alcohol and drug abuse prevention and treatment services for this workforce. Operationalizing this among highly mobile workforces, such as the construction trades, is a challenge. While not intending to minimize the problems of alcohol or substance abuse on the job among carpenters, the focus of prevention should not necessarily be in the workplace.
Lipscomb
Hester J
HJ
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA. hester.lipscomb@duke.edu
Dement
John M
JM
Li
Leiming
L
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D005160:Facility Design and Construction; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007750:Labor Unions; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000191:economics*; D014861:Washington; D014942:Workers' Compensation / Q000706:statistics & numerical data; D000078329:Workforce