title: On-site medical care in methadone maintenance: associations with health care use and expenditures.
abstract: To evaluate whether long-term drug treatment with on-site medical care is associated with diminished inpatient and outpatient service use and expenditures, we linked prospective interview data to concurrent Medicaid claims of drug users in a methadone program with comprehensive medical services. Patient care was classified as follows: long-term (>/=6 months) drug treatment with on-site usual source of medical care (linked care), long-term drug treatment only, or neither. Multivariate analyses adjusted for visit clustering within patients (n = 423, with 1,161 person-years of observation). After adjustment, linked care participants had more outpatient visits (p < .001), fewer emergency department (ED) visits (24% vs. 33%, p = .02) and fewer hospitalizations (27% vs. 40%, p = .002) than the "neither" group. Ambulatory care expenditures in the linked group were increased, whereas expenditures for other services were similar or reduced. Long-term drug treatment with on-site medical care was associated with increased ambulatory care, less ED and inpatient care, and no net increase in expenditures.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, NY 10016, USA. marc.gourevitch@med.nyu.edu
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
authors.forename: Pinka
authors.initials: P
authors.lastname: Chatterji
authors.forename: Nandini
authors.initials: N
authors.lastname: Deb
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D016000:Cluster Analysis; D015897:Comorbidity; D017046:Cost Savings / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D006679:HIV Seropositivity / Q000191:economics / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008484:Medicaid / Q000191:economics; D001523:Mental Disorders / Q000191:economics / Q000534:rehabilitation; D008691:Methadone / Q000191:economics* / Q000627:therapeutic use*; D015999:Multivariate Analysis; D009294:Narcotics / Q000191:economics* / Q000627:therapeutic use*; D009519:New York City; D009293:Opioid-Related Disorders / Q000191:economics* / Q000534:rehabilitation*; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000331:legislation & jurisprudence; D011446:Prospective Studies; D016320:Substance Abuse Treatment Centers / Q000191:economics* / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000191:economics* / Q000534:rehabilitation*; D014600:Utilization Review / Q000706:statistics & numerical data
chemical_list: D009294:Narcotics; D008691:Methadone