Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans

Kevin L. Kraemer, Kathleen A. McGinnis, David A. Fiellin, Melissa Skanderson, Adam J. Gordon, Jonathan Robbins, Susan Zickmund, Kendall Bryant, Philip (Todd) Korthuis

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)23-32
Number of pages10
JournalJournal of Substance Abuse Treatment
Volume103
DOIs
StatePublished - Aug 1 2019

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Veterans
Substance-Related Disorders
HIV
Drug Therapy
Therapeutics
International Classification of Diseases
Delivery of Health Care
Inpatients
Patient Care
Outpatients

Keywords

  • HIV
  • Opioid treatment
  • Pharmacotherapy
  • Substance use disorder treatment
  • Substance use disorders

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans. / Kraemer, Kevin L.; McGinnis, Kathleen A.; Fiellin, David A.; Skanderson, Melissa; Gordon, Adam J.; Robbins, Jonathan; Zickmund, Susan; Bryant, Kendall; Korthuis, Philip (Todd).

In: Journal of Substance Abuse Treatment, Vol. 103, 01.08.2019, p. 23-32.

Research output: Contribution to journalArticle

Kraemer, Kevin L. ; McGinnis, Kathleen A. ; Fiellin, David A. ; Skanderson, Melissa ; Gordon, Adam J. ; Robbins, Jonathan ; Zickmund, Susan ; Bryant, Kendall ; Korthuis, Philip (Todd). / Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans. In: Journal of Substance Abuse Treatment. 2019 ; Vol. 103. pp. 23-32.
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abstract = "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.",
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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, Philip (Todd)

PY - 2019/8/1

Y1 - 2019/8/1

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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