Specialty behavioral health service use among chronically ill medicare advantage patients with substance use problems.
OBJECTIVE
This study examines the use of substance abuse and mental health services among older adults with substance use disorders.


METHODS
Participants were members of Humana Cares, a subsidiary of Humana, Inc., a care management program for chronically ill Medicare Advantage members, between 2008 and 2010. All adults aged 65 and older with a substance use disorder identified with International Classification of Diseases-9 codes were included. We compared utilization of substance abuse and mental health services among participants with no psychiatric comorbidity (n = 585), with comorbid depression (n = 605), and with comorbid severe and persistent mental illness (severe and persistent mental illness, n = 95).


RESULTS
Twenty-eight percent utilized substance abuse services and 36% utilized mental health services. After adjusting for covariates, comorbid depression (odds ratio = 4.27, 95% confidence interval: 3.22-5.65) and severe and persistent mental illness (odds ratio = 10.75, 95% confidence interval: 5.22-20.13) were independently associated with specialty service use (either substance abuse or mental health services).


CONCLUSIONS
Although few chronically ill older adults with substance use disorders in this Medicare Advantage program received any specialty substance abuse or mental health services, utilization was higher among those who had concurrent psychiatric disorders.
Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA. Electronic address: Hhuang@cha.harvard.edu.
Hsiang
H
Huang
Ya-Fen
YF
Chan
Amy M
AM
Bauer
Joji
J
Suzuki
Wayne
W
Katon
Joan
J
Russo
Diane
D
Hogan
Jürgen
J
Unützer
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D020398:Medicare Part C; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D016017:Odds Ratio; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States