title: Continuity of care practices and substance use disorder patients' engagement in continuing care.
abstract: BACKGROUND
  Substance use disorder (SUD) patients who engage in more continuing care have better outcomes, but information on practices associated with greater patient engagement and retention in continuing care remains elusive.
  
  
  OBJECTIVE
  The objectives of this study were to determine if staff's continuity of care practices predict patients' engagement in continuing care in the 6 months after discharge from intensive SUD treatment and to determine if the impact of continuity of care practices on patients' engagement in continuing care differs for patients treated in inpatient/residential versus outpatient programs.
  
  
  METHODS
  Staff in 28 Veterans Affairs (VA) intensive SUD treatment programs with varying continuity of care practices provided data on 878 patients' alcohol and drug problems at treatment entry. At discharge, staff provided data on patients' motivation, treatment intensity, and on the continuity of care practices they used with each patient. VA administrative databases supplied data on patients' subsequent engagement in continuing care. Mixed-effects modeling was used to examine predictors of patients' engagement in care.
  
  
  RESULTS
  Patients in outpatient programs who received more continuity of care engaged in continuing care significantly longer. More highly motivated outpatients, those with fewer alcohol problems at treatment entry, and patients who used VA services in the year before treatment also remained in continuing care longer. These findings did not hold for patients treated in inpatient/residential programs.
  
  
  CONCLUSIONS
  Continuity of care practices predicted engagement in continuing care only for patients treated in outpatient SUD programs. More research is needed to identify effective continuity of care practices for patients treated in inpatient/residential programs.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, Palo Alto, CA, USA. Jeanne.Schaefer@med.va.gov
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Schaefer
authors.forename: Erin
authors.initials: E
authors.lastname: Ingudomnukul
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Cronkite
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007297:Inpatients; D008875:Middle Aged; D009042:Motivation; D010045:Outpatients; D010352:Patient Dropouts / Q000523:psychology*; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs