title: Substance use treatment barriers for patients with frequent hospital admissions.
abstract: Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.
authors.affiliation: Department of Emergency Medicine, Division of General Internal Medicine, NYU School of Medicine/Bellevue Hospital Center, New York, NY 10016, USA. maria.raven@med.nyu.edu
authors.forename: Maria C
authors.initials: MC
authors.lastname: Raven
authors.forename: Emily R
authors.initials: ER
authors.lastname: Carrier
authors.forename: Joshua
authors.initials: J
authors.lastname: Lee
authors.forename: John C
authors.initials: JC
authors.lastname: Billings
authors.forename: Mollie
authors.initials: M
authors.lastname: Marr
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D006300:Health Services Misuse / Q000639:trends*; D006703:Ill-Housed Persons; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D019966:Substance-Related Disorders / Q000628:therapy*; D014481:United States