title: Availability of medical care services in drug treatment clinics associated with lower repeated emergency department use.
abstract: BACKGROUND
  Drug users rely heavily on emergency departments (EDs) for care. Medical and other services in outpatient drug treatment clinics may reduce demand for ED care.
  
  
  OBJECTIVE
  The objective of this study was to examine the association of services in drug treatment clinics with repeated ED use by clinic patients.
  
  
  METHODS
  This study consisted of telephone interviews of directors of a stratified random sample of 125 New York state outpatient drug treatment clinics linked to Medicaid claims for patients with long-term (>or=6 months) treatment at these clinics.
  
  
  METHODS
  This study comprised a total of 8397 Medicare enrollees in surveyed clinics in 1996 to 1997.
  
  
  METHODS
  The surveys addressed drug treatment; general medical, HIV, alcohol, and social support services; location of selected services; primary care, HIV specialty, and mental health provider staffing levels; accessibility; and academic affiliation. From Medicaid claims, we defined patient demographic, clinical, and healthcare variables. Logistic regression models examined associations of availability of onsite medical services with repeated (2 or more) ED visits in 1997, adjusted for patient characteristics and patient clustering in clinics.
  
  
  RESULTS
  Repeated ED visits occurred in 15% of the cohort and were less likely when medical services were all onsite versus more distant (12.9% vs 16.8%, P<0.001). An interaction showed that onsite medical care was associated with less ED use only in low-volume (<or=1350 visits/wk, adjusted odds ratio [AOR] 0.64 [0.47-0.88]) and moderate volume (1351-2500 visits/wk, AOR 0.79 [0.64-0.97]) clinics. The availability of preventive services and HIV specialists onsite appear to mediate the beneficial effect of onsite medical care.
  
  
  CONCLUSIONS
  Greater onsite medical care in low- and moderate-volume drug treatment clinics was associated with less repeated ED use.
authors.affiliation: Division of Internal Medicine, Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Laine
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Lin
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009518:New York; D011314:Preventive Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*