TY - JOUR
T1 - Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans
AU - Kraemer, Kevin L.
AU - McGinnis, Kathleen A.
AU - Fiellin, David A.
AU - Skanderson, Melissa
AU - Gordon, Adam J.
AU - Robbins, Jonathan
AU - Zickmund, Susan
AU - Bryant, Kendall
AU - Korthuis, P. Todd
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Background: Substance use disorders (SUDs) are common in healthcare settings and contribute to poor outcomes, particularly in patients living with HIV. We assessed initiation, engagement, and retention in SUD treatment and pharmacotherapy following an index SUD episode in a national sample of HIV-infected and uninfected patients receiving care in the Department of Veterans Affairs (VA) healthcare system. Methods: We used electronic national VA data (years 2000–2015) from 52,995 HIV-infected and 111,229 age-, race-, gender-, and region-matched uninfected patients. We defined index SUD episodes as outpatient visits or inpatient/residential admissions with associated primary or secondary ICD-9 codes for substance use in patients without SUD-related services or pharmacotherapy in the preceding 5 months. Results: Overall, 57,428 (35%) patients had at least 1 index SUD episode. HIV-infected patients were more likely than uninfected controls to have at least one index SUD episode (35.7% vs. 34.6%; p < .001). Rates of initiation, engagement, and retention in SUD treatment after the index SUD episode were <17% for both groups. In adjusted models, HIV-infected patients were more likely than uninfected patients to be retained in SUD treatment at 6 months (Odds Ratio 1.10; 95% Confidence Interval 1.04–1.16). SUD pharmacotherapy initiation and engagement was uncommon in both HIV-infected and uninfected patients. Conclusions: In this national VA sample, initiation of SUD treatment and pharmacotherapy were uncommon for both HIV-infected and uninfected patients. Interventions to improve initiation, engagement, and retention in the full range of services, including SUD pharmacotherapy, are warranted for all patients with SUD in the VA.
AB - Background: Substance use disorders (SUDs) are common in healthcare settings and contribute to poor outcomes, particularly in patients living with HIV. We assessed initiation, engagement, and retention in SUD treatment and pharmacotherapy following an index SUD episode in a national sample of HIV-infected and uninfected patients receiving care in the Department of Veterans Affairs (VA) healthcare system. Methods: We used electronic national VA data (years 2000–2015) from 52,995 HIV-infected and 111,229 age-, race-, gender-, and region-matched uninfected patients. We defined index SUD episodes as outpatient visits or inpatient/residential admissions with associated primary or secondary ICD-9 codes for substance use in patients without SUD-related services or pharmacotherapy in the preceding 5 months. Results: Overall, 57,428 (35%) patients had at least 1 index SUD episode. HIV-infected patients were more likely than uninfected controls to have at least one index SUD episode (35.7% vs. 34.6%; p < .001). Rates of initiation, engagement, and retention in SUD treatment after the index SUD episode were <17% for both groups. In adjusted models, HIV-infected patients were more likely than uninfected patients to be retained in SUD treatment at 6 months (Odds Ratio 1.10; 95% Confidence Interval 1.04–1.16). SUD pharmacotherapy initiation and engagement was uncommon in both HIV-infected and uninfected patients. Conclusions: In this national VA sample, initiation of SUD treatment and pharmacotherapy were uncommon for both HIV-infected and uninfected patients. Interventions to improve initiation, engagement, and retention in the full range of services, including SUD pharmacotherapy, are warranted for all patients with SUD in the VA.
KW - HIV
KW - Opioid treatment
KW - Pharmacotherapy
KW - Substance use disorder treatment
KW - Substance use disorders
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U2 - 10.1016/j.jsat.2019.05.007
DO - 10.1016/j.jsat.2019.05.007
M3 - Article
C2 - 31229189
AN - SCOPUS:85065924956
SN - 0740-5472
VL - 103
SP - 23
EP - 32
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
ER -