Outpatient treatment entry and health care utilization after a combined medical/substance abuse intervention for hospitalized medical patients

CONTEXT: Drug-abusing patients utilize extensive amounts of health services resources, yet the acute medical hospitalization has typically not been used effectively to engage patients in substance abuse treatment. OBJECTIVES: To assess the effect of an integrated substance abuse/acute medical care day hospital (DH) intervention. DESIGN AND SETTING: Prospective, consecutive chart review of patients referred to a day hospital program from the medicine service at an urban tertiary care teaching hospital. From the referral cohort, a comparison group receiving usual care was identified. PARTICIPANTS: One hundred twenty adult medicine inpatients with active substance abuse and self-identified motivation to enter treatment. MAIN OUTCOME MEASURES: Outpatient substance abuse treatment entry and post-intervention health services utilization. RESULTS: Following DH treatment, 50.6% entered further outpatient substance abuse treatment (vs 2.4% comparison patients; P < .001). There was a significant increase in ambulatory medical visits for DH patients (pre-6 month 0.49 vs post-6 month 3.46; P < .001), greater than the change noted for comparison patients. However, there was no difference noted in pre-post hospitalization or emergency department utilization following the DH intervention. CONCLUSIONS: A DH program for substance abusing hospitalized medicine patients that introduces substance abuse treatment during treatment for an acute medical illness does appear to improve outpatient substance abuse treatment entry and ambulatory care utilization after hospital discharge.